Provider Demographics
NPI:1205933819
Name:KLAMATH PAIN CLINIC PC
Entity type:Organization
Organization Name:KLAMATH PAIN CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-882-2023
Mailing Address - Street 1:2301 MOUNTAIN VIEW BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-2023
Mailing Address - Fax:541-884-5681
Practice Address - Street 1:2301 MOUNTAIN VIEW BLVD
Practice Address - Street 2:STE B
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-2023
Practice Address - Fax:541-884-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO15593208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR205807OtherOMAP
ORR116706Medicaid
OR08WFBLJAMedicare ID - Type Unspecified
OR205807OtherOMAP