Provider Demographics
NPI:1437189818
Name:PAIN CONSULTANTS OF WASHINGTON, PLLC
Entity Type:Organization
Organization Name:PAIN CONSULTANTS OF WASHINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-6030
Mailing Address - Street 1:13123 121ST WAY NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3051
Mailing Address - Country:US
Mailing Address - Phone:425-899-6030
Mailing Address - Fax:425-899-6031
Practice Address - Street 1:13123 121ST WAY NE
Practice Address - Street 2:SUITE D
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3051
Practice Address - Country:US
Practice Address - Phone:425-899-6030
Practice Address - Fax:425-899-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026916208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5608570001OtherMEDICARE NORIDIAN ADMINIS
WA7125826Medicaid
WA0175948OtherL&I GROUP
WA5608570001Medicare NSC
WA5608570001OtherMEDICARE NORIDIAN ADMINIS
WA7125826Medicaid