Healthcare Provider Details

I. General information

NPI: 1619304714
Provider Name (Legal Business Name): SEATTLE PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 COLBY AVE SUITE B
EVERETT WA
98201-4776
US

IV. Provider business mailing address

3624 COLBY AVE SUITE B
EVERETT WA
98201-4776
US

V. Phone/Fax

Practice location:
  • Phone: 425-250-5551
  • Fax:
Mailing address:
  • Phone: 425-250-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAP60417676
License Number StateWA

VIII. Authorized Official

Name: FRANK LI
Title or Position: PAIN MANAGEMENT SPECIALIST
Credential: M.D.
Phone: 206-805-8885