1831133677 NPI number — EUGENE EMERGENCY PHYSICIANS PC

Table of content: (NPI 1831133677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831133677 NPI number — EUGENE EMERGENCY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUGENE EMERGENCY PHYSICIANS 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:
EUGENE EMRGNCY PHYSICIANS PC
Provider Other Organization Name Type Code:
5
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:
1831133677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97208-4078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-633-0086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1255 HILYARD ST
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:
97401-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-686-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
TOD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-484-9742

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 069315 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 292798001 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8922949 . This is a "WASHINGTON CRIME VICTIMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 057221000 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168123 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 379423200 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76160 . This is a "WASHINGTON L&I" identifier . This identifiers is of the category "OTHER".
  • Identifier: DZ4060 . This is a "PACC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7107451 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com