Provider Demographics
NPI:1912868225
Name:PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC-P
Entity type:Organization
Organization Name:PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC-P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING/CRED
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-953-0357
Mailing Address - Street 1:1711 WILLAMETTE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 WILLAMETTE ST STE 302
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4593
Practice Address - Country:US
Practice Address - Phone:541-780-6654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty