Provider Demographics
NPI:1851679583
Name:OREGON TRAIL HEALTH CARE
Entity Type:Organization
Organization Name:OREGON TRAIL HEALTH CARE
Other - Org Name:PCA PAIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRANCHISEE
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-909-9220
Mailing Address - Street 1:1693 SW CHANDLER AVE
Mailing Address - Street 2:260
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3236
Mailing Address - Country:US
Mailing Address - Phone:800-909-9220
Mailing Address - Fax:801-665-1882
Practice Address - Street 1:1693 SW CHANDLER AVE
Practice Address - Street 2:260
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3236
Practice Address - Country:US
Practice Address - Phone:800-909-9220
Practice Address - Fax:801-665-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty