Healthcare Provider Details

I. General information

NPI: 1760307656
Provider Name (Legal Business Name): SIDE BY SIDE PSYCHIATRIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 CRENSHAW RD
EUGENE OR
97401-2022
US

IV. Provider business mailing address

1151 CRENSHAW RD
EUGENE OR
97401-2022
US

V. Phone/Fax

Practice location:
  • Phone: 206-409-7491
  • Fax:
Mailing address:
  • Phone: 206-409-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MORTIMER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 206-409-7491