Provider Demographics
NPI:1114410495
Name:ADVANCED PAIN CARE PS
Entity type:Organization
Organization Name:ADVANCED PAIN CARE PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NAIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-200-5867
Mailing Address - Street 1:DEPT LA 24793
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-4793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 LILLY RD NE BLDG B
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-218-5990
Practice Address - Fax:866-308-9873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE WASHINGTON PRIVATE MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-11
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain