Provider Demographics
NPI:1598878522
Name:SANTA CLARA MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:SANTA CLARA MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-688-3000
Mailing Address - Street 1:217 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5429
Mailing Address - Country:US
Mailing Address - Phone:541-688-3000
Mailing Address - Fax:541-688-5368
Practice Address - Street 1:217 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5429
Practice Address - Country:US
Practice Address - Phone:541-688-3000
Practice Address - Fax:541-688-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOWFBKPMedicare ID - Type Unspecified
OR1184280001Medicare NSC