Basic Information
| Provider Information | |||||||||
| NPI: | 1295258697 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON CENTER FOR PAIN MANAGEMENT PLLC | ||||||||
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| OtherOrganizationName: | OLYMPIA PAIN & SPINE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 827 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980090827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4253327038 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 LILLY RD NE STE 2 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257741538 | ||||||||
| FaxNumber: | 4253327038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2017 | ||||||||
| LastUpdateDate: | 07/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | HONG | ||||||||
| AuthorizedOfficialFirstName: | JACKY | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4257741538 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WASHINGTON CENTER FOR PAIN MANAGEMENT PLLC | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.