1174794895 NPI number — FAYE AMEREDES DO PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174794895 NPI number — FAYE AMEREDES DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAYE AMEREDES DO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARMONY HEALTH FOR WOMEN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174794895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 816
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-677-4463
Provider Business Mailing Address Fax Number:
541-677-3379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 NW STEWART PKWY STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-677-4463
Provider Business Practice Location Address Fax Number:
541-677-3379
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
541-677-4463

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  DO22718 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 288143 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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