Provider Demographics
NPI:1104921824
Name:BELLINGHAM SPINE PAIN SPECIALISTS, P.S.
Entity type:Organization
Organization Name:BELLINGHAM SPINE PAIN SPECIALISTS, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:FLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-527-8111
Mailing Address - Street 1:2075 BARKLEY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6614
Mailing Address - Country:US
Mailing Address - Phone:360-527-8111
Mailing Address - Fax:360-527-8115
Practice Address - Street 1:2075 BARKLEY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-527-8111
Practice Address - Fax:360-527-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101959Medicaid
WAAB15327Medicare ID - Type UnspecifiedWA MEDICARE #