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OKANOGAN VALLEY ANESTHESIA CENTER FOR PAIN MANAGEMENT PLLC

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Company Details

Legal Name: OKANOGAN VALLEY ANESTHESIA CENTER FOR PAIN MANAGEMENT PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: August 5th 2020
Expiration date: 31 Aug 2025
UBI Number: 604 640 777
ZIP code: 98841
City: Omak
County: OKANOGAN
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 208 S MAIN ST, OMAK, WA, 98841-9755, UNITED STATES

Contact Details

E-Mail: OVANESTHESIACPM@GMAIL.COM
Phone Number: +1 509-740-2192

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
STEPHEN BOTH Registered Agent 208 S MAIN ST, OMAK, WA, 98841-9755, UNITED STATES

Key Officers & Management

Name Role Address
ERIC MATHISON Executor 105 VIEWMONT, OKANOGAN, WA, 98840-9424, UNITED STATES
STEPHEN BOTH Governing Person -

National Provider Identifier

NPI Number:
1073110029
Certification Date:
2025-01-28

Authorized Person:

Name:
STEPHEN K BOTH
Role:
OWNER/PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
367500000X - Certified Registered Nurse Anesthetist
Is Primary:
Yes

Contacts:

Fax:
5092232244
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