Healthcare Provider Details

I. General information

NPI: 1912654179
Provider Name (Legal Business Name): SIMON THOMAS BACHOFNER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 CALAPOOIA ST SW STE 101
ALBANY OR
97321-2258
US

IV. Provider business mailing address

331 CALAPOOIA ST SW STE 101
ALBANY OR
97321-2258
US

V. Phone/Fax

Practice location:
  • Phone: 541-866-6988
  • Fax: 541-243-1800
Mailing address:
  • Phone: 541-866-6988
  • Fax: 541-243-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202202206NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202202206NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: