MEDICARE: DR. KELLY H CAIN D.O.

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	207L00000X	Anesthesiology Physician	OP00002248	WA

General Provider Information

NPI Number	:	1083795157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY H CAIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0368
Country	:	US
Telephone Number	:	360-455-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 CAPITAL MALL DR SW STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8654
Country	:	US
Telephone Number	:	360-528-8571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/27/2026

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