Basic Information
| Provider Information | |||||||||
| NPI: | 1982907119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PAIN MANAGEMENT CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13684 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981981010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065925000 | ||||||||
| FaxNumber: | 2068249510 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 N DIVISION ST | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980014931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533331637 | ||||||||
| FaxNumber: | 2533518509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 12/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | VIELAVICIUS | ||||||||
| AuthorizedOfficialFirstName: | MINDAUGAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2533331637 | ||||||||
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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 | MD00042920 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.