Organization
PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC
Active
Other names
Pacific Sports and Spine
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE REA (PRACTICE MANAGER)
(541) 743-9003
Entity
Organization
Contact information
Practice address
217 DIVISION AVE, EUGENE, OR 97404-5429
(541) 686-3791
(541) 686-3795
Mailing address
217 DIVISION AVE, EUGENE, OR 97404-5429
(541) 743-9003
(541) 284-0520
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
MD27887
OR
208VP0014X
Interventional Pain Medicine Physician
MD28629
OR
363A00000X
Physician Assistant
PA00420
OR
363A00000X
Physician Assistant
PA00800
OR
363A00000X
Physician Assistant
PA152998
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244117
—
OR
05
—
500604467
—
OR
05
—
500608609
—
OR
05
—
500624453
—
OR
05
—
500632183
—
OR
Enumeration date
05/31/2018
Last updated
11/06/2023
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