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Contact Information

PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC
217 DIVISION AVE
EUGENE, OR97404-5429
 Phone: 541-686-3791
 Fax: 541-686-3795
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC

NPI Number 1881186336
LBN Legal business name PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC
Authorized official LESLIE REA - (PRACTICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/31/2018
Last updated 11/06/2023 - About 3 years ago
Identifiers
OR License # MD27887
OR License # MD28629
OR License # PA00420
OR License # PA00800
OR License # PA152998
OR Medicaid 244117
OR Medicaid 500604467
OR Medicaid 500608609
OR Medicaid 500624453
OR Medicaid 500632183
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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