MEDICARE: OREGON BREAST CARE

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R116985	OTHER	OR	MEDICARE ID

General Provider Information

NPI Number	:	1851577720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON BREAST CARE

Provider Business Mailing Address
First Line	:	2852 WILLAMETTE ST
Second Line	:	PMB 405
City	:	EUGENE
State	:	OR
Zip	:	97405-8200
Country	:	US
Telephone Number	:	541-997-5290
Fax Number	:	866-583-6791

Provider Business Practice Location Address
First Line	:	2852 WILLAMETTE ST
Second Line	:	PMB 405
City	:	EUGENE
State	:	OR
Zip	:	97405-8200
Country	:	US
Telephone Number	:	541-997-5290
Fax Number	:	866-583-6791

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MS. REBECCA LYNN PARQUET
Credential	:
Telephone Number	:	541-997-5290

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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Directions to “OREGON BREAST CARE ” Practice Location

Language	Start Address	Practice Location

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