Provider Demographics
NPI:1366500589
Name:PAIN CONSULTANTS OF OREGON PC
Entity Type:Organization
Organization Name:PAIN CONSULTANTS OF OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GESSELE
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:97401-8034
Mailing Address - Country:US
Mailing Address - Phone:541-684-9451
Mailing Address - Fax:
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:97401-8034
Practice Address - Country:US
Practice Address - Phone:541-684-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181155Medicaid
ORR101474Medicare ID - Type Unspecified