Basic Information
| Provider Information | |||||||||
| NPI: | 1922089085 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN CONSULTANTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9927 MICKELBERRY RD NW | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606922330 | ||||||||
| FaxNumber: | 3606922329 | ||||||||
| Practice Location | |||||||||
| Address1: | 9927 MICKELBERRY RD NW | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606922330 | ||||||||
| FaxNumber: | 3606922329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | MERIFIELD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3606922330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7129547 | 05 | WA | MEDICAID |