Provider Demographics
NPI:1972789204
Name:SPINE INTERVENTION CLINIC, P.C.
Entity Type:Organization
Organization Name:SPINE INTERVENTION CLINIC, P.C.
Other - Org Name:MICHAEL BESPALY, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BESPALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-742-0632
Mailing Address - Street 1:PO BOX 1836
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0836
Mailing Address - Country:US
Mailing Address - Phone:503-742-0632
Mailing Address - Fax:503-387-3106
Practice Address - Street 1:512 7TH STREET
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1853
Practice Address - Country:US
Practice Address - Phone:503-742-0632
Practice Address - Fax:503-387-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20637207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46723Medicare UPIN