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General NPI Number Information
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NPI Number | 1841487451
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Entity Type | Organization
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Legal Business Name | ALTERNATIVE MEDICINE OUTREACH PROGRAM
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 455 W COREY CT
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City | ROSEBURG
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State | OR
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Zip | 97470-3078
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Country | US
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Telephone | 541-440-1934
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Fax | 541-440-1943
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Provider Business Mailing Address
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Address Line | 455 W COREY CT
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City | ROSEBURG
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State | OR
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Zip | 97470-3078
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Country | US
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Telephone | 541-440-1934
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Fax | 541-440-1943
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DONNA GAIL EIDE
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Credential |
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Telephone | 15414401934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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