Healthcare Provider Details

I. General information

NPI: 1912298290
Provider Name (Legal Business Name): THE WASHINGTON CENTER FOR PAIN MANAGEMENT SLEEP LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W SUITE 102
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

21616 76TH AVE W #102
EDMONDS WA
98026-7512
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-1538
  • Fax: 425-744-1527
Mailing address:
  • Phone: 425-774-1538
  • Fax: 425-744-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LESLEY MENG
Title or Position: CREDENTIALING & COMPLIANCE LIAISON
Credential:
Phone: 425-774-1538