Healthcare Provider Details

I. General information

NPI: 1992999775
Provider Name (Legal Business Name): SPINE SURGERY CENTER OF EUGENE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 OAK ST SUITE 300
EUGENE OR
97401-4604
US

IV. Provider business mailing address

1410 OAK ST SUITE 300
EUGENE OR
97401-4604
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3666
  • Fax: 541-228-3667
Mailing address:
  • Phone: 541-228-3666
  • Fax: 541-228-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: P EVALYN COLE
Title or Position: CEO/ADMINISTRATOR
Credential: MHSA, CASC
Phone: 541-228-3666