MEDICARE: SOUND PAIN ALLIANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	OP00001595	WA
2	261Q00000X	Clinic/Center
3	261QP3300X	Pain Clinic/Center	OP00001595	WA
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	261QP3300X	Pain Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053431684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUND PAIN ALLIANCE

Provider Business Mailing Address
First Line	:	PO BOX 39324
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98496-3324
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:	253-983-0066

Provider Business Practice Location Address
First Line	:	11306 BRIDGEPORT WAY SW
Second Line	:	#D
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:	253-983-0066

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERIKA STUIT
Credential	:
Telephone Number	:	360-752-0518

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/22/2019

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Directions to “SOUND PAIN ALLIANCE ” Practice Location

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