Provider Demographics
NPI:1245587674
Name:PAIN CONSULTANTS OF OREGON PC
Entity Type:Organization
Organization Name:PAIN CONSULTANTS OF OREGON PC
Other - Org Name:OREGON ANALYTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-684-9451
Mailing Address - Street 1:360 S GARDEN WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8173
Mailing Address - Country:US
Mailing Address - Phone:541-684-9451
Mailing Address - Fax:541-684-9566
Practice Address - Street 1:360 S GARDEN WAY STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8173
Practice Address - Country:US
Practice Address - Phone:541-868-0149
Practice Address - Fax:541-868-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D1047176291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory