Provider Demographics
NPI:1538565015
Name:ANDERSON NEUROLOGICAL PAIN SOLUTIONS LLC
Entity type:Organization
Organization Name:ANDERSON NEUROLOGICAL PAIN SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-760-9644
Mailing Address - Street 1:2211 NW PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3891
Mailing Address - Country:US
Mailing Address - Phone:541-760-9644
Mailing Address - Fax:
Practice Address - Street 1:2211 NW PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3891
Practice Address - Country:US
Practice Address - Phone:541-760-9644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO159457261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty