Provider Demographics
NPI:1417035031
Name:APPLEGATE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:APPLEGATE MEDICAL ASSOCIATES
Other - Org Name:APPLEGATE MEDICAL ASSOCIATES - EAST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-868-1876
Mailing Address - Street 1:689 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4304
Mailing Address - Country:US
Mailing Address - Phone:541-868-1876
Mailing Address - Fax:541-868-0932
Practice Address - Street 1:689 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4304
Practice Address - Country:US
Practice Address - Phone:541-868-1876
Practice Address - Fax:541-868-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08934261Q00000X
ORMD11435261Q00000X
ORMD16571261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR222810Medicaid
OR230482Medicaid
OR071324Medicaid
OR011WCGWSBMedicare ID - Type Unspecified
ORD73071Medicare UPIN
ORF99681Medicare UPIN
OR134559Medicare ID - Type Unspecified
OR222810Medicaid
OR071324Medicaid