Healthcare Provider Details

I. General information

NPI: 1669114385
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9370 SW GREENBURG RD STE 602
TIGARD OR
97223-5429
US

IV. Provider business mailing address

4029 NORTHWEST AVE STE 310
BELLINGHAM WA
98226-9077
US

V. Phone/Fax

Practice location:
  • Phone: 503-238-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIKA STUIT
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 360-752-0518