MEDICARE: LANE EMERGENCY PHYSICIANS, LLC

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
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1750233094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANE EMERGENCY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	5665 NEW NORTHSIDE DR STE 320
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5834
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 RIVERBEND DR
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-222-7300
Fax Number	:

Authorized Official
Title or Position	:	VP, CREDENTIALING
Name	:	KIM LARSEN
Credential	:
Telephone Number	:	770-874-5400

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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