Provider Demographics
NPI:1558376335
Name:CASCADE INTERVENTIONAL PAIN CENTER PLLC
Entity Type:Organization
Organization Name:CASCADE INTERVENTIONAL PAIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAISIMHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-627-2666
Mailing Address - Street 1:PO BOX 731689
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-627-2666
Mailing Address - Fax:253-627-8661
Practice Address - Street 1:1818 S UNION
Practice Address - Street 2:SUITE 1 A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-627-2666
Practice Address - Fax:253-627-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036006208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF61871Medicare UPIN
WAAB25892Medicare ID - Type Unspecified