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PACIFIC SPORTS AND INTERVENTIONAL SPINE LLC NPI 1881186336


NPI Information

NPI: 1881186336
Provider Name: PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC

Doing Business As: PACIFIC SPORTS AND SPINE

Classification: Pain Medicine - 208VP0014X
Entity Type: Organization

Specialization: Interventional Pain Medicine

Address:
74B CENTENNIAL LOOP STE 100
EUGENE, OR
ZIP 97401
Phone: (541) 686-3791
Get Directions

PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC is an interventional pain medicine pain medicine in Eugene, OR. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC NPI is 1881186336. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Pacific Sports And Spine.

The provider's business location address is:

74B CENTENNIAL LOOP STE 100
EUGENE, OR
ZIP 97401-919
Phone: (541) 686-3791
Fax: (541) 686-3795

The provider's authorized official is Sam Derrick .
The authorized official title is Administrator and has the following contact phone number (541) 686-3791.

The enumeration date for this NPI number is 5/31/2018 and was last updated on 11/29/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208VP0014XPain MedicineInterventional Pain MedicineMD28629OREGONNo
2363A00000XPhysician AssistantPA00800OREGONNo
3363A00000XPhysician AssistantPA00420OREGONNo
4363A00000XPhysician AssistantPA152998OREGONNo
5208VP0014XPain MedicineInterventional Pain MedicineMD27887OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1500624453MEDICAIDOREGON
2244117MEDICAIDOREGON
3500608609MEDICAIDOREGON
4500632183MEDICAIDOREGON
5500604467MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.