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NPI Code Detail

MEDICARE: SAMUEL EMILE RUTHERFORD DR.

MEDICARE: SAMUEL EMILE RUTHERFORD DR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorT-16-097OR
2101YM0800XMental Health Counselor
3103TC0700XClinical Psychologist20043782BIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477962173
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL EMILE RUTHERFORD DR.
Provider Business Mailing Address
First Line : 1255 PEARL ST STE 101
Second Line :
City : EUGENE
State : OR
Zip : 97401-3570
Country : US
Telephone Number : 541-799-5386
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-544-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2014
Last Update Date : 08/19/2024

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Directions to “ SAMUEL EMILE RUTHERFORD DR.” Practice Location

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