Provider Demographics
NPI:1255302881
Name:ADVANCED PAIN MEDICINE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-564-2009
Mailing Address - Street 1:1628 S MILDRED ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1627
Mailing Address - Country:US
Mailing Address - Phone:253-564-2009
Mailing Address - Fax:
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:SUITE 105
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1627
Practice Address - Country:US
Practice Address - Phone:253-564-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115207Medicaid
WA8328593Medicaid
WAGAB18030Medicare PIN
WA7115207Medicaid
WAGAB18030Medicare ID - Type Unspecified