Organization
PAIN RELIEF SPECIALIST NORTHWEST PC
Active
Organization
PAIN RELIEF SPECIALIST NORTHWEST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD ALAN MCCLUSKEY MD (OWNER OPERATOR)
(503) 382-8100
Entity
Organization
Contact information
Practice address
831 NW COUNCIL DR, SUITE 300, GRESHAM, OR 97030-3721
(503) 382-8100
(503) 382-8120
Mailing address
831 NW COUNCIL DR, SUITE 300, GRESHAM, OR 97030-3721
(503) 382-8100
(503) 382-8120
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
648952
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130333
—
OR
01
—
1391489
HEALTH CARE RESOURCES NW
—
01
—
307446
MHN
—
05
—
7118037
—
WA
01
—
808594000
REGENCE
—
01
—
CK2353
RR MEDICARE
—
01
—
O166607
LABOR & IND
WA
Enumeration date
06/03/2006
Last updated
05/14/2008
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