Basic Information
| Provider Information | |||||||||
| NPI: | 1225572381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACUTE PAIN MANAGEMENT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 116TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254403351 | ||||||||
| FaxNumber: | 4254403439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 116TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254403351 | ||||||||
| FaxNumber: | 4254403439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2016 | ||||||||
| LastUpdateDate: | 12/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | SORENSEN | ||||||||
| AuthorizedOfficialFirstName: | KIRSTEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 6024311152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD60216841 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | MD60491842 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD60491842 | 01 | WA | WA LICENSE | OTHER |