Organization
COLUMBIA PAIN AND SPINE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLEG MAKSIMOV MD (PRESIDENT)
(503) 915-9217
Entity
Organization
Contact information
Practice address
689 NW BURNSIDE ROAD, GRESHAM, OR 97030
(503) 382-8100
(503) 382-8120
Mailing address
689 NW BURNSIDE ROAD, GRESHAM, OR 97030-8014
(503) 382-8100
(503) 382-8120
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
MD 28526
OR
261QP3300X
Pain Clinic/Center
MD60054432
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500632340
—
OR
Enumeration date
10/08/2010
Last updated
05/23/2021
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