Healthcare Provider Details

I. General information

NPI: 1366500589
Provider Name (Legal Business Name): PAIN CONSULTANTS OF OREGON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GARDEN WAY STE 101
EUGENE OR
97401-8034
US

IV. Provider business mailing address

360 S GARDEN WAY STE 101
EUGENE OR
97401-8034
US

V. Phone/Fax

Practice location:
  • Phone: 541-684-9451
  • Fax:
Mailing address:
  • Phone: 541-684-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier181155
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: ROBERT GESSELE
Title or Position: ADMINISTRATOR
Credential:
Phone: 541-684-9451