Healthcare Provider Details

I. General information

NPI: 1629884135
Provider Name (Legal Business Name): OREGON HEALTHCARE RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COUNTRY CLUB RD STE 100
EUGENE OR
97401-2240
US

IV. Provider business mailing address

PO BOX 1648
EUGENE OR
97440-1648
US

V. Phone/Fax

Practice location:
  • Phone: 541-463-2390
  • Fax: 541-463-2889
Mailing address:
  • Phone: 541-242-4384
  • Fax: 541-563-2820

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:

VIII. Authorized Official

Name: THOMAS GLEN GRAGNOLA
Title or Position: OWNER OF OHR PHYSICIAN GROUP, P.C.
Credential: MD
Phone: 503-731-7518