Healthcare Provider Details

I. General information

NPI: 1114553229
Provider Name (Legal Business Name): PAIN GPS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 OAK ST
EUGENE OR
97401-4022
US

IV. Provider business mailing address

2852 WILLAMETTE ST STE 400
EUGENE OR
97405-8200
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-3400
  • Fax: 541-246-3421
Mailing address:
  • Phone: 541-246-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY SCOTT JOHNSTON
Title or Position: CFO
Credential:
Phone: 702-339-8602