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General NPI Number Information
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NPI Number | 1326539834
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Entity Type | Organization
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Legal Business Name | NORTHWEST PAIN SPECIALISTS LLC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 8819 W VICTORIA AVE
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City | KENNEWICK
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State | WA
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Zip | 99336
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Country | US
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Telephone | 509-460-5500
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Fax | 509-460-5111
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Provider Business Mailing Address
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Address Line | PO BOX 2589
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2589
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL LEGG
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Credential | M.D.
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Telephone | 614-625-5805
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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 | 60674447
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License Number State | WA
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