Provider Demographics
NPI:1538219993
Name:NORTHWEST PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:NORTHWEST PAIN MANAGEMENT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PURTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-770-1650
Mailing Address - Street 1:1322 E MCANDREWS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6177
Mailing Address - Country:US
Mailing Address - Phone:541-770-1650
Mailing Address - Fax:541-773-2470
Practice Address - Street 1:1322 E MCANDREWS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6177
Practice Address - Country:US
Practice Address - Phone:541-770-1650
Practice Address - Fax:541-773-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12880261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDD5160OtherRAILROAD MEDICARE
OH146753OtherOREGON WELFARE
OH146753OtherOREGON WELFARE
OR131944Medicare ID - Type Unspecified