Healthcare Provider Details

I. General information

NPI: 1588497515
Provider Name (Legal Business Name): LANE COUNTY OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 7TH AVE STE 210
EUGENE OR
97401-2676
US

IV. Provider business mailing address

151 W 7TH AVE STE 210
EUGENE OR
97401-2676
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax:
Mailing address:
  • Phone: 541-682-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier500845272
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MICHELLE LYNN PETERSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 541-682-7987