Healthcare Provider Details

I. General information

NPI: 1982008975
Provider Name (Legal Business Name): SURGICAL PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GOLF VIEW DR
MEDFORD OR
97504
US

IV. Provider business mailing address

PO BOX 4034
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-227-8697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD157375
License Number StateOR

VIII. Authorized Official

Name: DR. BRETT T. QUAVE
Title or Position: OWNER / PHYSICIAN
Credential:
Phone: 541-227-8697