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WILD ROSE MEDICAL CLINIC PC NPI 1083762637


NPI Information

NPI: 1083762637
Provider Name: WILD ROSE MEDICAL CLINIC PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
401 E 10TH AVE
SUITE 250
EUGENE, OR
ZIP 97401
Phone: (541) 686-4153
Get Directions

WILD ROSE MEDICAL CLINIC PC is a family medicine in Eugene, OR. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. WILD ROSE MEDICAL CLINIC PC NPI is 1083762637. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

401 E 10TH AVE
SUITE 250
EUGENE, OR
ZIP 97401-317
Phone: (541) 686-4153
Fax: (541) 686-3468

The provider's authorized official is Kathleen Cordes .
The authorized official title is President and has the following contact phone number (541) 686-4153.

The enumeration date for this NPI number is 1/8/2007 and was last updated on 10/10/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine16009OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1R131120MEDICARE PINOREGON
2C45172MEDICARE UPINOREGON
3P00193941MEDICARE ID-TYPE UNSPECIFIEDOREGONRAIL ROAD MEDICARE
4072173MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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