Provider Demographics
NPI:1376972182
Name:OREGON SPINE CARE LLC
Entity Type:Organization
Organization Name:OREGON SPINE CARE LLC
Other - Org Name:OREGON SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATSUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-828-1150
Mailing Address - Street 1:19255 SW 65TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7451
Mailing Address - Country:US
Mailing Address - Phone:503-828-1150
Mailing Address - Fax:503-828-1160
Practice Address - Street 1:19255 SW 65TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7451
Practice Address - Country:US
Practice Address - Phone:503-828-1150
Practice Address - Fax:503-828-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26166207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty