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General NPI Number Information
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NPI Number | 1215135272
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Entity Type | Organization
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Legal Business Name | NORTHWEST COMPREHENSIVE PAIN CONSULTANTS INC P S
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 125 N 18TH ST STE # B
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City | MOUNT VERNON
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State | WA
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Zip | 98273-3902
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Country | US
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Telephone | 360-336-0123
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Fax | 360-336-0126
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Provider Business Mailing Address
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Address Line | 125 N 18TH ST STE # B
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City | MOUNT VERNON
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State | WA
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Zip | 98273-3902
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Country | US
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Telephone | 360-336-0123
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Fax | 360-336-0126
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIAN ELAINE JOHNSTON
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Credential | MD
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Telephone | 360-336-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD00035789
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License Number State | WA
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