Provider Demographics
NPI:1568645547
Name:CASCADE INTERVENTIONAL PAIN CENTER
Entity type:Organization
Organization Name:CASCADE INTERVENTIONAL PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-627-2666
Mailing Address - Street 1:PO BOX 111750
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1750
Mailing Address - Country:US
Mailing Address - Phone:253-627-2666
Mailing Address - Fax:253-627-8661
Practice Address - Street 1:1818 S UNION
Practice Address - Street 2:STUITE 1A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-627-2666
Practice Address - Fax:253-627-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB25892Medicare PIN
F61871Medicare UPIN