Provider Demographics
NPI:1225114929
Name:IPP PC
Entity Type:Organization
Organization Name:IPP PC
Other - Org Name:INTERVENTIONAL PAIN PROGRAM, ERICSON HAND AND NERVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-486-1000
Mailing Address - Street 1:PO BOX 28970
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-8970
Mailing Address - Country:US
Mailing Address - Phone:425-486-1000
Mailing Address - Fax:425-939-5220
Practice Address - Street 1:1629 220TH ST SE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8466
Practice Address - Country:US
Practice Address - Phone:425-486-1000
Practice Address - Fax:425-939-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0156259OtherLABOR & INDUSTRIES
WA0156259OtherLABOR & INDUSTRIES