Provider Demographics
NPI:1841471901
Name:THE PAIN CENTER OF WESTERN WASHINGTON, PLLC
Entity type:Organization
Organization Name:THE PAIN CENTER OF WESTERN WASHINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-874-8774
Mailing Address - Street 1:350 S 333RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6321
Mailing Address - Country:US
Mailing Address - Phone:253-874-8774
Mailing Address - Fax:253-874-8775
Practice Address - Street 1:350 S 333RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6321
Practice Address - Country:US
Practice Address - Phone:253-874-8774
Practice Address - Fax:253-874-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040719208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8806155Medicare UPIN