Healthcare Provider Details

I. General information

NPI: 1053431684
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 BRIDGEPORT WAY SW #D
LAKEWOOD WA
98499-3037
US

IV. Provider business mailing address

PO BOX 39324
LAKEWOOD WA
98496-3324
US

V. Phone/Fax

Practice location:
  • Phone: 253-983-9390
  • Fax: 253-983-0066
Mailing address:
  • Phone: 253-983-9390
  • Fax: 253-983-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOP00001595
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberOP00001595
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

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