Healthcare Provider Details

I. General information

NPI: 1467585901
Provider Name (Legal Business Name): PSYCHIATRY ASSOCIATES OF EUGENE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WILLAMETTE ST 2
EUGENE OR
97405-3309
US

IV. Provider business mailing address

3225 WILLAMETTE ST 2
EUGENE OR
97405-3309
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-7313
  • Fax: 541-302-6676
Mailing address:
  • Phone: 541-686-7313
  • Fax: 541-302-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15717
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier8000894
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerHMOO
# 2
Identifier058388
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
IdentifierJ3064
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICSOURCE INSURANCE

VIII. Authorized Official

Name: DR. MICHAEL DAVID WEBB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-686-7313