MEDICARE: NORTHWEST PAIN INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1427674324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PAIN INSTITUTE

Provider Business Mailing Address
First Line	:	2005 CEDAR ST
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1701
Country	:	US
Telephone Number	:	503-883-8297
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 CEDAR ST
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1701
Country	:	US
Telephone Number	:	503-883-8297
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	TREVOR JORGENSEN
Credential	:	MD
Telephone Number	:	503-883-8297

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	07/27/2020

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Directions to “NORTHWEST PAIN INSTITUTE ” Practice Location

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