Provider Demographics
NPI:1740434356
Name:PINNACLE PAIN CENTER, PS
Entity type:Organization
Organization Name:PINNACLE PAIN CENTER, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:509-987-1977
Practice Address - Street 1:7401 W HOOD PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3400
Practice Address - Country:US
Practice Address - Phone:509-591-0070
Practice Address - Fax:509-987-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092681Medicaid