Healthcare Provider Details

I. General information

NPI: 1578994851
Provider Name (Legal Business Name): EUGENE FOOT AND ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CHAMBERS ST STE 201
EUGENE OR
97402-3655
US

IV. Provider business mailing address

1680 CHAMBERS ST
EUGENE OR
97402-3655
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-3351
  • Fax: 541-683-6440
Mailing address:
  • Phone: 541-683-3351
  • Fax: 541-683-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberDP152629
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. MICHAEL JOHN MCCOURT
Title or Position: OWNER
Credential: DPM
Phone: 541-683-3351