1548628308 NPI number — MS. HEATH WEAVER-HALL CADC I, QMHA, CRSP

Table of content: MS. HEATH WEAVER-HALL CADC I, QMHA, CRSP (NPI 1548628308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548628308 NPI number — MS. HEATH WEAVER-HALL CADC I, QMHA, CRSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEAVER-HALL
Provider First Name:
HEATH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CADC I, QMHA, CRSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEAVER
Provider Other First Name:
HEATH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
QMHA, CADC 1, CRSP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548628308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 CENTENNIAL PLAZA
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:
97401-6107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-485-6340
Provider Business Mailing Address Fax Number:
541-984-3124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 CENTENNIAL PLZ
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:
97401-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-485-6340
Provider Business Practice Location Address Fax Number:
541-984-3124
Provider Enumeration Date:
02/08/2016

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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