Provider Demographics
NPI:1760142095
Name:RENEW, LLC
Entity Type:Organization
Organization Name:RENEW, LLC
Other - Org Name:RENEW VASCULAR INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR RCM
Authorized Official - Phone:541-302-7771
Mailing Address - Street 1:675 OAK ST STE 400
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2673
Mailing Address - Country:US
Mailing Address - Phone:541-302-5240
Mailing Address - Fax:541-344-2025
Practice Address - Street 1:10 COBURG RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7481
Practice Address - Country:US
Practice Address - Phone:541-681-8586
Practice Address - Fax:541-681-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty