Healthcare Provider Details

I. General information

NPI: 1245529163
Provider Name (Legal Business Name): OREGON HEALTHCARE RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COUNTRY CLUB RD SUITE 210B
EUGENE OR
97401-6024
US

IV. Provider business mailing address

PO BOX 1648
EUGENE OR
97440-1648
US

V. Phone/Fax

Practice location:
  • Phone: 541-242-4172
  • Fax: 541-242-4171
Mailing address:
  • Phone: 541-687-4900
  • Fax: 541-687-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier6501380008
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerDME PTAN

VIII. Authorized Official

Name: BRENDA A. SHETER
Title or Position: SUPPORT SERVICES MANAGER
Credential:
Phone: 541-687-4900