Provider Demographics
NPI:1386277267
Name:INTERVENTIONAL PAIN GROUP OF BELLEVUE PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN GROUP OF BELLEVUE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-409-7100
Mailing Address - Street 1:304 S WATER ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:206-409-7100
Mailing Address - Fax:425-984-1531
Practice Address - Street 1:1220 116TH AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:206-409-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL PAIN GROUP OF BELLEVUE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty