Healthcare Provider Details

I. General information

NPI: 1073534004
Provider Name (Legal Business Name): EUGENE SPRINGFIELD NEPHROLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

IV. Provider business mailing address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6478
  • Fax: 541-485-0452
Mailing address:
  • Phone: 541-485-6478
  • Fax: 541-485-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD08565
License Number StateOR

VIII. Authorized Official

Name: ABIGAIL FAIR
Title or Position: CLINICAL OPERATIONS MANAGER
Credential:
Phone: 541-868-9251