Healthcare Provider Details

I. General information

NPI: 1881810745
Provider Name (Legal Business Name): VALLEY MED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COBURG RD STE 201
EUGENE OR
97401-7487
US

IV. Provider business mailing address

10 COBURG RD STE 201
EUGENE OR
97401-7487
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-8581
  • Fax: 541-343-1411
Mailing address:
  • Phone: 541-687-8581
  • Fax: 541-343-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number791258-87
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WINSLOW
Title or Position: MANAGER
Credential:
Phone: 541-687-8581