NPIMap

Organization Active NPI

Alpha Spine and Pain Clinic PLLC

  • Interventional Pain Medicine Physician
  • Puyallup, WA
National Provider Identifier
1033815352
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
ALPHA SPINE AND PAIN CLINIC PLLC
Practice address
120 14TH Ave SE Ste B
Puyallup, WA 98372-3718
Phone
(425) 777-4710
Fax
(888) 830-1615
NPI assigned
Feb 7, 2023
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Praveen Kumar MambalamNPI 1790942886
Title
MD
Phone
(425) 774-1538

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

120 14TH Ave SE Ste B
Puyallup, WA 98372-3718

Mailing address

PO Box 827
Bellevue, WA 98009-0827
Phone (425) 777-1538

National Provider Directory

National Provider Directory
Tax ID family
Alpha Spine and Pain Clinic PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1033815352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 827",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980090827",
            "telephone_number": "425-777-1538",
            "fax_number": "888-830-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 14TH AVE SE STE B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723718",
            "telephone_number": "425-777-4710",
            "fax_number": "888-830-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA SPINE AND PAIN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "MAMBALAM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "425-774-1538"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.