Healthcare Provider Details

I. General information

NPI: 1801812078
Provider Name (Legal Business Name): OREGON UROLOGY INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HARTMAN LN STE 200
SPRINGFIELD OR
97477-1122
US

IV. Provider business mailing address

2400 HARTMAN LN STE 200
SPRINGFIELD OR
97477-1122
US

V. Phone/Fax

Practice location:
  • Phone: 541-334-3350
  • Fax: 541-284-5198
Mailing address:
  • Phone: 541-334-3350
  • Fax: 541-284-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRYAN A MEHLHAFF
Title or Position: EXECUTIVE MEMBER
Credential: MD
Phone: 541-334-3350