Healthcare Provider Details

I. General information

NPI: 1285805853
Provider Name (Legal Business Name): ERIC ALAN COVELY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 OAK ST
EUGENE OR
97401-4022
US

IV. Provider business mailing address

1613 OAK ST
EUGENE OR
97401-4022
US

V. Phone/Fax

Practice location:
  • Phone: 541-954-6809
  • Fax: 541-343-8466
Mailing address:
  • Phone: 541-954-6809
  • Fax: 541-343-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2731
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: