Provider Demographics
NPI:1821341223
Name:COLUMBIA PAIN AND SPINE INSTITUTE
Entity Type:Organization
Organization Name:COLUMBIA PAIN AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-382-8152
Mailing Address - Street 1:831 NW COUNCIL DR
Mailing Address - Street 2:#300
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-382-8100
Mailing Address - Fax:503-382-8120
Practice Address - Street 1:831 NW COUNCIL DR
Practice Address - Street 2:#300
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-382-8100
Practice Address - Fax:503-382-8120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA PAIN AND SPINE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D2018576291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500632340Medicaid
OR00851OtherBLUE CROSS
OR500632340Medicaid
OR1972813962Medicare UPIN