Provider Demographics
NPI:1053431684
Name:SOUND PAIN ALLIANCE
Entity type:Organization
Organization Name:SOUND PAIN ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-752-0518
Mailing Address - Street 1:PO BOX 39324
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-3324
Mailing Address - Country:US
Mailing Address - Phone:253-983-9390
Mailing Address - Fax:253-983-0066
Practice Address - Street 1:11306 BRIDGEPORT WAY SW
Practice Address - Street 2:#D
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3037
Practice Address - Country:US
Practice Address - Phone:253-983-9390
Practice Address - Fax:253-983-0066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUGET SOUND PAIN CLINIC, P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001595208VP0014X, 261QP3300X
261Q00000X, 261QP3300X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121882Medicaid
WAG70313Medicare UPIN
WA7121882Medicaid