1467570077 NPI number — UNIVERSITY OF OREGON

Table of content: (NPI 1467570077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467570077 NPI number — UNIVERSITY OF OREGON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF OREGON
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:
6
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:
1467570077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1232 UNIVERSITY OF OREGON
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:
97403-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-346-3572
Provider Business Mailing Address Fax Number:
541-346-2747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1232 UNIVERSITY OF OREGON
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:
97403-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-346-3572
Provider Business Practice Location Address Fax Number:
541-346-2747
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNADER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICALDIRECTOR
Authorized Official Telephone Number:
541-346-4456

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X , with the licence number: 936001786 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110148 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com