Provider Demographics
NPI:1659934982
Name:EQUINOX CLINICS LLC
Entity Type:Organization
Organization Name:EQUINOX CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMSC PAC
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-418-8222
Mailing Address - Street 1:160 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4160
Mailing Address - Country:US
Mailing Address - Phone:206-418-8222
Mailing Address - Fax:
Practice Address - Street 1:160 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4160
Practice Address - Country:US
Practice Address - Phone:541-790-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty