Provider Demographics
NPI:1871814301
Name:PAIN INSTITUTE OF OREGON
Entity type:Organization
Organization Name:PAIN INSTITUTE OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-238-7246
Mailing Address - Street 1:527 SE CESAR E CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3214
Mailing Address - Country:US
Mailing Address - Phone:503-238-7246
Mailing Address - Fax:503-238-7248
Practice Address - Street 1:527 SE CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3214
Practice Address - Country:US
Practice Address - Phone:503-238-7246
Practice Address - Fax:503-238-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR074062Medicaid
OR074062Medicaid
OR130869Medicare PIN