Healthcare Provider Details

I. General information

NPI: 1578760740
Provider Name (Legal Business Name): MY SCHOOL'S HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SILVER LN
EUGENE OR
97404-2216
US

IV. Provider business mailing address

120 W HILLIARD AVENUE
EUGENE OR
97404-3012
US

V. Phone/Fax

Practice location:
  • Phone: 541-790-4445
  • Fax: 541-790-4446
Mailing address:
  • Phone: 541-790-7216
  • Fax: 541-790-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5043
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201050226NP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2276647
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOMAP #

VIII. Authorized Official

Name: MS. MAXINE PROSKUROWSKI
Title or Position: PROGRAM MANAGER
Credential: MSRN
Phone: 541-790-7215