MEDICARE: PEACEHEALTH MEDICAL GROUP

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

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

General Provider Information

NPI Number	:	1912013590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEHEALTH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 24410
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-0451
Country	:	US
Telephone Number	:	541-349-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 W 7TH AVE
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-1619
Country	:	US
Telephone Number	:	541-998-6314
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WENDY APLAND
Credential	:
Telephone Number	:	541-686-3968

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/14/2009

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Directions to “PEACEHEALTH MEDICAL GROUP ” Practice Location

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