Willamette Pain and Spine Center, PC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

MD26192 Issued in OR

Legal business name

WILLAMETTE PAIN AND SPINE CENTER, PC

Practice address

2020 8TH Ave
Suite 200
West Linn, OR 97068-4657

Phone

(503) 512-1212

Fax

(503) 512-1220

NPI assigned

Feb 22, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Gullo, MD

Title

President

Phone

(503) 512-1212

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1982977849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE",
            "address_2": "SUITE 200",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-512-1212",
            "fax_number": "503-512-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE",
            "address_2": "SUITE 200",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-512-1212",
            "fax_number": "503-512-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE PAIN AND SPINE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-22",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "GULLO",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-512-1212",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OR",
            "license": "MD26192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willamette Clinic, LLC
• Willamette Eye Health LLC
• Willamette Falls Chiropractic Clinic, LLC
• Willamette Falls Hospital
• Willamette Nurse Consultant Group LLC
• Willamette Procedure Center PC
• Kelly Anne Williams, RN
• Anne Marie Wilson, RN
• Megan Nichole Wimberly, FNP-BC
• Addison Brown Wise, PT, DPT

• Pain Medicine (Anesthesiology) Physician in West Linn, OR
• Providers in West Linn, OR by specialty
• Pain Medicine (Anesthesiology) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.