Provider Demographics
NPI:1871032193
Name:CASCADE PAIN PLLC
Entity Type:Organization
Organization Name:CASCADE PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMBALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-563-6274
Mailing Address - Street 1:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009
Mailing Address - Country:US
Mailing Address - Phone:425-563-6274
Mailing Address - Fax:
Practice Address - Street 1:6323 111TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1303
Practice Address - Country:US
Practice Address - Phone:425-563-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty