Provider Demographics
NPI:1134163413
Name:PAIN ASSOCIATES PC
Entity type:Organization
Organization Name:PAIN ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CSABA
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-887-2209
Mailing Address - Street 1:527 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3214
Mailing Address - Country:US
Mailing Address - Phone:503-238-7246
Mailing Address - Fax:503-238-7248
Practice Address - Street 1:527 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3214
Practice Address - Country:US
Practice Address - Phone:503-238-7246
Practice Address - Fax:503-238-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023248Medicaid
OR023248Medicaid