Provider Demographics
NPI:1942675467
Name:PAIN CARE SPECIALISTS OF OREGON, LLC
Entity Type:Organization
Organization Name:PAIN CARE SPECIALISTS OF OREGON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-371-1010
Mailing Address - Street 1:2480 LIBERTY ST NE STE 180
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8388
Mailing Address - Country:US
Mailing Address - Phone:503-371-1010
Mailing Address - Fax:503-371-0805
Practice Address - Street 1:2480 LIBERTY ST NE STE 180
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8388
Practice Address - Country:US
Practice Address - Phone:503-371-1010
Practice Address - Fax:503-371-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty