Provider Demographics
NPI:1932523990
Name:INTEGRATED PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-473-9412
Mailing Address - Street 1:9130 E FRASER CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6083
Mailing Address - Country:US
Mailing Address - Phone:509-954-3759
Mailing Address - Fax:509-808-2180
Practice Address - Street 1:507 S WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2604
Practice Address - Country:US
Practice Address - Phone:509-473-9412
Practice Address - Fax:509-808-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60186765163WP0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2083461Medicaid
WA2083461Medicaid