Healthcare Provider Details

I. General information

NPI: 1679256358
Provider Name (Legal Business Name): PORTLAND ORTHO PAIN & SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10415 SE STARK ST STE F
PORTLAND OR
97216-2764
US

IV. Provider business mailing address

10415 SE STARK ST STE F
PORTLAND OR
97216-2764
US

V. Phone/Fax

Practice location:
  • Phone: 702-630-3472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW M CASH
Title or Position: PROVIDER
Credential: MD
Phone: 775-309-4761