Provider Demographics
NPI:1558815779
Name:PINNACLE PAIN CENTER PS
Entity Type:Organization
Organization Name:PINNACLE PAIN CENTER PS
Other - Org Name:SPOKANE PAIN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-578-8846
Mailing Address - Street 1:8524 W GAGE BLVD
Mailing Address - Street 2:BLDG A-1 BOX 319
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8241
Mailing Address - Country:US
Mailing Address - Phone:509-591-0070
Mailing Address - Fax:509-396-9661
Practice Address - Street 1:12709 E MIRABEAU PKWY
Practice Address - Street 2:BLDG A STE 200
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1455
Practice Address - Country:US
Practice Address - Phone:509-591-0070
Practice Address - Fax:509-396-9661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE PAIN CENTER PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty