Provider Demographics
NPI:1467773663
Name:ADVANCED PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-595-9001
Mailing Address - Street 1:10305 SW PARK WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5028
Mailing Address - Country:US
Mailing Address - Phone:503-595-9001
Mailing Address - Fax:503-295-0731
Practice Address - Street 1:10305 SW PARK WAY
Practice Address - Street 2:STE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5028
Practice Address - Country:US
Practice Address - Phone:503-595-9001
Practice Address - Fax:503-295-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1760531339Medicare PIN