Provider Demographics
NPI:1215135272
Name:NORTHWEST COMPREHENSIVE PAIN CONSULTANTS INC P S
Entity type:Organization
Organization Name:NORTHWEST COMPREHENSIVE PAIN CONSULTANTS INC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-336-0123
Mailing Address - Street 1:125 N 18TH ST
Mailing Address - Street 2:STE # B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3902
Mailing Address - Country:US
Mailing Address - Phone:360-336-0123
Mailing Address - Fax:360-336-0126
Practice Address - Street 1:125 N 18TH ST
Practice Address - Street 2:STE # B
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3902
Practice Address - Country:US
Practice Address - Phone:360-336-0123
Practice Address - Fax:360-336-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035789207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117589Medicaid
WAG99182Medicare UPIN