# PAIN CARE PHYSICIANS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619530839
- **Authorized official:** KEVIN MOON (DIRECTOR OF REVENUE AND FINANCE)
- **Authorized official phone:** (206) 538-6300

## Contact information

- **Practice address:** 155 LILLY RD NE STE B, OLYMPIA, WA 98506-5028
- **Practice address phone:** (206) 538-6300
- **Practice address fax:** (206) 538-6301
- **Mailing address:** 801 SW 16TH ST STE 121, RENTON, WA 98057-2628
- **Mailing address phone:** (206) 538-6300
- **Mailing address fax:** (206) 538-6301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/15/2019
- **Last updated:** 07/21/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1144779232 | BILLING NPI | — |
| 01 | — | 50C0001329 | MEDICARE CERTIFICATION NUMBER | WA |