Provider Demographics
NPI:1578760740
Name:MY SCHOOL'S HEALTH CENTERS
Entity Type:Organization
Organization Name:MY SCHOOL'S HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKUROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSRN
Authorized Official - Phone:541-790-7215
Mailing Address - Street 1:120 W HILLIARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3012
Mailing Address - Country:US
Mailing Address - Phone:541-790-7216
Mailing Address - Fax:541-790-7217
Practice Address - Street 1:200 SILVER LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2216
Practice Address - Country:US
Practice Address - Phone:541-790-4445
Practice Address - Fax:541-790-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5043103TC1900X
OR201050226NP363LF0000X, 363LF0000X
OR00035723363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2276647OtherOMAP #
OR=========OtherTIN