Provider Demographics
NPI:1639122187
Name:LANE GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:LANE GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-726-4686
Mailing Address - Street 1:10 COBURG RD.
Mailing Address - Street 2:#201
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-726-4686
Mailing Address - Fax:541-726-5056
Practice Address - Street 1:10 COBURG RD.
Practice Address - Street 2:#201
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-726-4686
Practice Address - Fax:541-726-5056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANE GASTROENTEROLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR23548-1Medicaid
OR0000WCJWGMedicare PIN