Healthcare Provider Details

I. General information

NPI: 1184788796
Provider Name (Legal Business Name): INTEGRATED HEALTH CLINICS OF EUGENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LINCOLN ST
EUGENE OR
97401-2502
US

IV. Provider business mailing address

715 LINCOLN ST
EUGENE OR
97401-2502
US

V. Phone/Fax

Practice location:
  • Phone: 541-344-3574
  • Fax: 541-344-5652
Mailing address:
  • Phone: 541-344-3574
  • Fax: 541-344-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier230475
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MS. PATRICIA A. EWING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-344-3574