Healthcare Provider Details

I. General information

NPI: 1750487120
Provider Name (Legal Business Name): PEACEHEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST
EUGENE OR
97401-8122
US

IV. Provider business mailing address

PO BOX 24410
EUGENE OR
97402-0451
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-6119
  • Fax:
Mailing address:
  • Phone: 541-349-7683
  • Fax:

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
Identifier071634
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: WENDY APLAND
Title or Position: CFO
Credential:
Phone: 541-686-3968