Provider Demographics
NPI:1235953654
Name:COMPASS PAIN CLINIC OREGON PC
Entity type:Organization
Organization Name:COMPASS PAIN CLINIC OREGON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-887-2209
Mailing Address - Street 1:9527 NW ARBORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6380
Mailing Address - Country:US
Mailing Address - Phone:503-887-2209
Mailing Address - Fax:
Practice Address - Street 1:1410 SW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2548
Practice Address - Country:US
Practice Address - Phone:503-946-9704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty