Alpha Spine and Pain Clinic PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

ALPHA SPINE AND PAIN CLINIC PLLC

Practice address

3202 Colby Ave Ste B
Everett, WA 98201-4324

Phone

(425) 753-6705

NPI assigned

Mar 19, 2021

Organization subpart

No

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

Authorized official

Name

Praveen Mambalam

Title

MD

Phone

(425) 753-6705

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1962088013",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 COLBY AVE STE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014324",
            "telephone_number": "425-753-6705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3525 Ensign Rd NE Ste A",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985065065",
            "country_code": "US",
            "telephone_number": "425-777-4710",
            "fax_number": "888-830-1615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALPHA SPINE AND PAIN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "MAMBALAM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "425-753-6705"
    },
    "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": []
}

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• Interventional Pain Medicine Physician in Everett, WA
• Providers in Everett, WA by specialty
• Interventional Pain Medicine Physician in Washington

• 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.