Provider Demographics
NPI:1467667063
Name:JEFFREY BURCH MS LLC
Entity Type:Organization
Organization Name:JEFFREY BURCH MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-689-1515
Mailing Address - Street 1:880 NANTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2720
Mailing Address - Country:US
Mailing Address - Phone:541-689-1515
Mailing Address - Fax:541-689-7419
Practice Address - Street 1:880 NANTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2720
Practice Address - Country:US
Practice Address - Phone:541-689-1515
Practice Address - Fax:541-689-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9092261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center