Healthcare Provider Details

I. General information

NPI: 1164720942
Provider Name (Legal Business Name): PIERCEY NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SW 3RD ST
CORVALLIS OR
97333-4437
US

IV. Provider business mailing address

650 SW 3RD STREET
CORVALLIS OR
97333-4437
US

V. Phone/Fax

Practice location:
  • Phone: 541-207-3900
  • Fax: 541-207-3232
Mailing address:
  • Phone: 541-207-3900
  • Fax: 541-207-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD22463
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SYDNEY C. PIERCEY
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 54120739000