Provider Demographics
NPI:1053601179
Name:NORTHWEST PAIN CARE, PS
Entity type:Organization
Organization Name:NORTHWEST PAIN CARE, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN OF NORTHWEST &PAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:HATHEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-863-9789
Mailing Address - Street 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0418
Mailing Address - Country:US
Mailing Address - Phone:509-863-9789
Mailing Address - Fax:509-255-7793
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-863-9789
Practice Address - Fax:855-630-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000475514208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty