1467585901 NPI number — PSYCHIATRY ASSOCIATES OF EUGENE, PC

Table of content: (NPI 1467585901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467585901 NPI number — PSYCHIATRY ASSOCIATES OF EUGENE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRY ASSOCIATES OF EUGENE, 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:
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:
1467585901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3225 WILLAMETTE ST
Provider Second Line Business Mailing Address:
2
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405-3309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-686-7313
Provider Business Mailing Address Fax Number:
541-302-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 WILLAMETTE ST
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97405-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-686-7313
Provider Business Practice Location Address Fax Number:
541-302-6676
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-686-7313

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  15717 , 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: 8000894 . This is a "HMOO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 058388 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: J3064 . This is a "PACIFICSOURCE INSURANCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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