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NPI Code Detail

MEDICARE: NORTHWEST SPINE AND PAIN MEDICINE, PLLC

MEDICARE: NORTHWEST SPINE AND PAIN MEDICINE, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1669789228
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST SPINE AND PAIN MEDICINE, PLLC
Provider Business Mailing Address
First Line : PO BOX 112
Second Line :
City : SPOKANE
State : WA
Zip : 99210-0112
Country : US
Telephone Number : 509-464-6208
Fax Number : 888-316-1928
Provider Business Practice Location Address
First Line : 3124 S REGAL ST
Second Line :
City : SPOKANE
State : WA
Zip : 99223-4704
Country : US
Telephone Number : 509-464-6208
Fax Number : 888-316-1928
Authorized Official
Title or Position : CEO
Name : JAMIE LEE LEWIS
Credential : MD
Telephone Number : 509-464-6208
Provider Enumeration Date : 09/02/2010
Last Update Date : 08/26/2019

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Directions to “NORTHWEST SPINE AND PAIN MEDICINE, PLLC ” Practice Location

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