Pacific Sports And Interventional Spine, LLC-P
Pain Medicine, Interventional Pain Medicine in Sutherlin, OR. Organization (NPI-2).
NPI number1215898564
StatusActive
Last updated in NPPESNov 18, 2025
Details
- NPI
- 1215898564
- Entity type
- Organization (NPI-2)
- Legal business name
- Pacific Sports And Interventional Spine, LLC-P
- Organization subpart
- No
- Enumeration date
- Nov 18, 2025
- Certification date
- Nov 18, 2025
- Last updated
- Nov 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208VP0014X | Pain Medicine, Interventional Pain Medicine | – | – | Yes |
Practice location
123 Ponderosa DrSutherlin, OR 97479-9812
Phone 541-543-2323
Mailing address
123 Ponderosa DrSutherlin, OR 97479-9812
Authorized official
Kristin Bunch
Director Of Contracting/Cred
5039530357
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