1578760740 NPI number — MY SCHOOL'S HEALTH CENTERS

Table of content: (NPI 1578760740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578760740 NPI number — MY SCHOOL'S HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY SCHOOL'S HEALTH CENTERS
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:
Provider Other Organization Name Type Code:
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:
1578760740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 W HILLIARD AVENUE
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:
97404-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-790-7216
Provider Business Mailing Address Fax Number:
541-790-7217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SILVER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97404-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-790-4445
Provider Business Practice Location Address Fax Number:
541-790-4446
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PROSKUROWSKI
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
541-790-7215

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  5043 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 201050226NP , 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: 2276647 . This is a "OMAP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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