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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