Healthcare Provider Details

I. General information

NPI: 1700247491
Provider Name (Legal Business Name): LANE EDUCATION SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGHWAY 99 N
EUGENE OR
97402-2014
US

IV. Provider business mailing address

1200 HIGHWAY 99 N
EUGENE OR
97402-2014
US

V. Phone/Fax

Practice location:
  • Phone: 541-461-8251
  • Fax: 541-461-8298
Mailing address:
  • Phone: 541-461-8251
  • Fax: 541-461-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier2064
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerEDUCATION

VIII. Authorized Official

Name: SUE MATHISEN
Title or Position: DIRECTOR, SPECIAL EDUCATION
Credential: MS
Phone: 541-461-8251