Provider Demographics
NPI:1518354752
Name:SOUND PAIN ALLIANCE
Entity Type:Organization
Organization Name:SOUND PAIN ALLIANCE
Other - Org Name:PUGET SOUND PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-641-5613
Mailing Address - Street 1:11306 BRIDGEPORT WAY SW STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3037
Mailing Address - Country:US
Mailing Address - Phone:253-983-9390
Mailing Address - Fax:253-983-0066
Practice Address - Street 1:7200 S 180TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-5548
Practice Address - Country:US
Practice Address - Phone:253-983-9390
Practice Address - Fax:253-983-0066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUGET SOUND PAIN CLINIC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-24
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001595208VP0014X
261QA1903X, 332B00000X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8883642OtherMEDICARE PTAN