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General NPI Number Information
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NPI Number | 1497193650
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Entity Type | Organization
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Legal Business Name | PENINSULA PAIN RELIEF CENTER
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 5050 STATE HIGHWAY 303 NE SUITE A101
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City | BREMERTON
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State | WA
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Zip | 98311-3629
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Country | US
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Telephone | 360-478-9788
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Fax | 360-405-6255
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Provider Business Mailing Address
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Address Line | 5050 STATE HIGHWAY 303 NE SUITE A101
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City | BREMERTON
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State | WA
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Zip | 98311-3629
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Country | US
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Telephone | 360-478-9788
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Fax | 360-405-6255
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LARRY MIGGINS
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Credential |
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Telephone | 360-478-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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