Provider Demographics
NPI:1558668400
Name:PAIN ASSOCIATES OF WASHINGTON PLLC
Entity Type:Organization
Organization Name:PAIN ASSOCIATES OF WASHINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-412-3280
Mailing Address - Street 1:4300 TALBOT RD S STE 200
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-412-3280
Mailing Address - Fax:425-412-3281
Practice Address - Street 1:4300 TALBOT RD S STE 200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-412-3280
Practice Address - Fax:425-412-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60103131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty