Healthcare Provider Details

I. General information

NPI: 1184680498
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 RIDGETOP BLVD NW
SILVERDALE WA
98383-8556
US

IV. Provider business mailing address

9220 RIDGETOP BLVD NW STE 200
SILVERDALE WA
98383-8556
US

V. Phone/Fax

Practice location:
  • Phone: 360-415-9110
  • Fax: 360-479-0265
Mailing address:
  • Phone: 360-415-9110
  • Fax: 360-479-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
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