Provider Demographics
NPI:1033721261
Name:OPPENHEIMER SPINE & PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:OPPENHEIMER SPINE & PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-706-8272
Mailing Address - Street 1:28037 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3079
Mailing Address - Country:US
Mailing Address - Phone:313-209-3353
Mailing Address - Fax:313-406-7255
Practice Address - Street 1:28037 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3079
Practice Address - Country:US
Practice Address - Phone:313-209-3353
Practice Address - Fax:313-406-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty