Healthcare Provider Details

I. General information

NPI: 1104876820
Provider Name (Legal Business Name): BHS EUGENE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 WESTEC DR
EUGENE OR
97402-9189
US

IV. Provider business mailing address

1455 WESTEC DR
EUGENE OR
97402-9189
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-1490
  • Fax: 541-868-1495
Mailing address:
  • Phone: 541-868-1490
  • Fax: 541-868-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberIP-0001887CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-0001886CS
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier241332
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier027953
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
Identifier6028849
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier3814301
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP

VIII. Authorized Official

Name: MR. KENNETH A ZIENTARA
Title or Position: PRESIDENT
Credential: RPH
Phone: 541-868-1490