PACIFIC NORTHWEST PAIN CENTER - NPI NUMBER 1114295300

Summary

Provider Name: PACIFIC NORTHWEST PAIN CENTER

NPI Number: 1114295300

Clasification: Anesthesiology (207LP2900X)

Specialization: Pain Medicine

Address:
2312 NE 129TH ST
VANCOUVER, WA
ZIP 98686

Phone Number: (360) 696-5022



Detailed Information

PACIFIC NORTHWEST PAIN CENTER is a pain medicine anesthesiologist in Vancouver, WA. The provider is an anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. The assigned NPI number for this provider is 1114295300 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

2312 NE 129TH ST
VANCOUVER, WA
ZIP 98686-236
Phone: (360) 696-5022
Fax: (360) 696-5445

The provider's authorized official is Benjamin J Platt .
The authorized official title is President and has the following contact phone number (360) 696-5022.

The enumeration date for this NPI number is 12/2/2011 and was last updated on 12/2/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207LP2900X Anesthesiology Pain Medicine MD60109781 WA Yes

NPI Record

No. Field Name Field Value
1 NPI 1114295300
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name PACIFIC NORTHWEST PAIN CENTER
5 Provider First Line Business Practice Location Address 2312 NE 129TH ST
6 Provider Business Practice Location Address City Name VANCOUVER
7 Provider Business Practice Location Address State Name WA
8 Provider Business Practice Location Address Postal Code 986863236
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 3606965022
11 Provider Business Practice Location Address Fax Number 3606965445
12 Provider Enumeration Date 12/2/2011
13 Last Update Date 12/2/2011
14 Authorized Official Last Name PLATT
15 Authorized Official First Name BENJAMIN
16 Authorized Official Middle Name J
17 Authorized Official Title or Position PRESIDENT
18 Authorized Official Telephone Number 3606965022
19 Healthcare Provider Taxonomy Code 1 207LP2900X
20 Provider License Number 1 MD60109781
21 Provider License Number State Code 1 WA
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart N
24 Authorized Official Name Prefix Text DR.
25 Authorized Official Credential Text MD
26 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 7/15/2014
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