PENINSULA PAIN CLINIC, PLLC (NPI# 1912376005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1912376005 |
Entity Type | Organization |
Organization Name | PENINSULA PAIN CLINIC, PLLC |
Practice Address |
2601 Cherry Ave Ste 200 Bremerton WA 98310-4208 |
Mailing Address |
2980 N Beverly Glen Cir Ste 100 Los Angeles CA 90077-1728 |
Practice Telephone | 3604159110 |
Practice Fax Number | 3604790265 |
Mailing Telephone | 3109434180 |
Mailing Fax Number | 8884318819 |
Enumeration Date | 2015-09-18 |
Last Update Date | 2019-07-22 |
Authorized Official Name | TERRY PEXTON (MEDICAL DIRECTOR) |
Authorized Official Telephone | 3604159110 |
Authorized Official Credential | DO |
Is Organization Subpart | Y |
Parent Organization Name | PENINSULA PAIN CLINIC, PLLC |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
N | 332900000X | Non-Pharmacy Dispensing Site | OP60339103 | WA | Suppliers |
Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
Street Address |
2601 CHERRY AVE STE 200 |
City | BREMERTON |
State | WA |
Zip Code | 98310-4208 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184680498 | Sound Pain Alliance | Anesthesiology | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2006-04-25 |
1790325637 | Marisa Lynne Bouquet | Nurse Practitioner | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2020-01-08 |
1619481421 | Tia Ramirez | Registered Nurse | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2017-12-01 |
1790174142 | Jessett Tyler Pocuis | Nurse Practitioner | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2015-01-22 |
1770908907 | Wesley D Sumrall | Physician Assistant | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2014-02-25 |
1235256272 | Vaughn Theodore Howe | Physician Assistant | 2601 Cherry Ave Ste 200, Bremerton, WA 98310-4208 | 2007-03-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891333613 | Miss Mary Community Development | Voluntary or Charitable | 1630 Trenton Avenue Apt 10, Bremerton, WA 98310 | 2019-12-11 |
1629636055 | Puget Sound Work Injury Clinic, LLC | Clinic/Center | 812 Cherry Ct, Bremerton, WA 98310 | 2019-05-31 |
1538672530 | Rachel E Mittelstaedt Parsons | Dietitian, Registered | 3059 Viewcrest Dr Ne, Bremerton, WA 98310 | 2017-11-13 |
1356888937 | Sarah Hike | Community Health Worker | 900 Sheridan, Bremerton, WA 98310 | 2017-01-20 |
1073941142 | Hana Singer | Physical Therapy Assistant | 3600 Forest Dr Ne, Bremerton, WA 98310 | 2013-10-28 |
1447508122 | Kevin Lee Hathaway | Mechanotherapist | 3308 Veska Avenue, Bremerton, WA 98310 | 2012-08-28 |
1003163007 | James Hyun Soo Lee | Surgery | Cvn 76 Uss Ronald Reagan, Bremerton, WA 98310 | 2012-08-08 |
1487936241 | Karen S Casseday | Nurse Practitioner | 1740 Ne Riddell Rd Ste 110, Bremerton, WA 98310 | 2011-09-16 |
1740560572 | Lauren P Foresman | Physician Assistant | 2709 Hemlock Street, Bremerton, WA 98310 | 2011-08-24 |
1538390059 | Patricia L Rushon | Speech-Language Pathologist | 560 Lebo Blvd., Bremerton, WA 98310 | 2009-07-31 |
Find all providers in zip 98310 |
Taxonomy Code | 261QP3300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Pain |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114410495 | Advanced Pain Care Ps | Clinic/Center | 300 Lilly Rd Ne Ste C, Olympia, WA 98506-5428 | 2018-06-11 |
1689912859 | Seattle Pain and Wellness Institute | Clinic/Center | 4701 41st Ave., Sw, Suite 120, Seattle, WA 98116 | 2013-01-23 |
1669742714 | B Fit Preventive Care Clinic | Clinic/Center | 1715 Pacific Ave N, Suite B, Long Beach, WA 98631-3604 | 2012-01-06 |
1053531780 | Doctors Osteopathic Care | Clinic/Center | 9629 Evergreen Way Ste 102, Everett, WA 98204-7169 | 2007-04-26 |
1386751774 | United Backcare Ps | Clinic/Center | 126 15th St Se, Puyallup, WA 98372-3409 | 2006-08-23 |
1568579944 | United Backcare Ps | Clinic/Center | 9617 7th Ave Se, Everett, WA 98208-3710 | 2006-08-23 |
1023125499 | United Backcare Ps | Clinic/Center | 2515 140th Ave Ne, Ste E110, Bellevue, WA 98005-1862 | 2006-08-23 |
1902420326 | Sound Pain Alliance Pllc | Clinic/Center | 120 14th Ave Se Ste D, Puyallup, WA 98372-3718 | 2020-06-01 |
1134684079 | John R Quigley Jr. | Clinic/Center | 129 176th St S, Spanaway, WA 98387-4616 | 2019-02-05 |
1376034694 | Serendib Pain Care Pllc | Clinic/Center | 2312 Ne 129th St, Vancouver, WA 98686-3236 | 2018-05-22 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.