1386786101 NPI number — DEBBIE AHEARN OTR

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 1386786101 NPI number — DEBBIE AHEARN OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHEARN
Provider First Name:
DEBBIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGRATH
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386786101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50056
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405-0967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-688-9595
Provider Business Mailing Address Fax Number:
541-688-1818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2866 CRESCENT AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97408-7342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-688-9595
Provider Business Practice Location Address Fax Number:
541-688-1818
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  988571 , 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: 800895101 . This is a "REGENCE MEDADVANTAGE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 230553 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00396773 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 838406001 . This is a "REGENCE BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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