Healthcare Provider Details

I. General information

NPI: 1114148186
Provider Name (Legal Business Name): OLYMPIA PAIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 LILLY RD NE
OLYMPIA WA
98506-5028
US

IV. Provider business mailing address

PO BOX 5277
LACEY WA
98509-5277
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-3361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEMITRI ADARMES
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 360-352-3361