Healthcare Provider Details

I. General information

NPI: 1477852457
Provider Name (Legal Business Name): MARY J THIMMESCH L.AC., MSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W BROADWAY
EUGENE OR
97401-2869
US

IV. Provider business mailing address

110 N JACKSON ST
EUGENE OR
97402-4236
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-6337
  • Fax:
Mailing address:
  • Phone: 541-684-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01080
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: