Healthcare Provider Details

I. General information

NPI: 1013114172
Provider Name (Legal Business Name): HEALING SPIRIT INTEGRATIVE HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

IV. Provider business mailing address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1125
  • Fax: 541-683-2049
Mailing address:
  • Phone: 541-683-1125
  • Fax: 541-683-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number200841796RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number201508020RN
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number81001432RN(N3)
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number080045015NS
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARMA JB DOUGLAS
Title or Position: PRESIDENT AND NURSE PRACTITIONER
Credential: NP
Phone: 541-683-1125