Provider Demographics
NPI:1558751958
Name:WASHINGTON CENTER FOR PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:WASHINGTON CENTER FOR PAIN MANAGEMENT LLC
Other - Org Name:OREGON PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-774-1538
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0827
Mailing Address - Country:US
Mailing Address - Phone:425-774-1538
Mailing Address - Fax:
Practice Address - Street 1:11786 SW BARNES RD
Practice Address - Street 2:SUITE 270
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5929
Practice Address - Country:US
Practice Address - Phone:503-828-9569
Practice Address - Fax:503-828-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty