=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487637013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAINIER ANESTHESIA ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2005
-----------------------------------------------------
Last Update Date | 03/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 E PIONEER STE 101
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-445-5828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1737
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98401-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-445-5828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEAD OF GROUP
-----------------------------------------------------
Name | BRIAN WALLACE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-447-2353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------