Healthcare Provider Details

I. General information

NPI: 1881694867
Provider Name (Legal Business Name): SLOCUM ORTHOPEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COBURG RD
EUGENE OR
97401
US

IV. Provider business mailing address

55 COBURG RD
EUGENE OR
97401-2433
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-8111
  • Fax: 541-868-0883
Mailing address:
  • Phone: 541-485-8111
  • Fax: 541-868-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: MR. JOHN BAUMAN
Title or Position: CHIEF ADMINISTRATOR
Credential:
Phone: 541-485-8111