=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710029889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREGON PSYCHIATRIC PARTNERS LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 09/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3203 WILLAMETTE ST
-----------------------------------------------------
City | EUGENE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97405-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-726-9912
-----------------------------------------------------
Fax | 541-744-4443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3203 WILLAMETTE ST
-----------------------------------------------------
City | EUGENE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97405-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-726-9912
-----------------------------------------------------
Fax | 541-744-4443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. NICHOLAS W TELEW
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 541-726-9912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------