Healthcare Provider Details

I. General information

NPI: 1528067758
Provider Name (Legal Business Name): SOUTH EUGENE SURGI-CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E 19TH AVE
EUGENE OR
97401-4304
US

IV. Provider business mailing address

675 E 19TH AVE
EUGENE OR
97401-4304
US

V. Phone/Fax

Practice location:
  • Phone: 541-284-5184
  • Fax: 541-284-5185
Mailing address:
  • Phone: 541-284-5184
  • Fax: 541-284-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number071530
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MICHAEL E KARASEK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 541-284-5184