Healthcare Provider Details

I. General information

NPI: 1184178949
Provider Name (Legal Business Name): PAIN CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SW 16TH ST SUITE 121
RENTON WA
98057-2697
US

IV. Provider business mailing address

PO BOX 88357
TUKWILA WA
98138-2357
US

V. Phone/Fax

Practice location:
  • Phone: 206-805-8885
  • Fax: 206-805-8886
Mailing address:
  • Phone: 206-805-8885
  • Fax: 206-805-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG FRANKLIN
Title or Position: CONTROLLER
Credential:
Phone: 206-805-8885