Provider Demographics
NPI:1831133677
Name:EUGENE EMERGENCY PHYSICIANS PC
Entity Type:Organization
Organization Name:EUGENE EMERGENCY PHYSICIANS PC
Other - Org Name:EUGENE EMRGNCY PHYSICIANS PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-484-9742
Mailing Address - Street 1:PO BOX 4078
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4078
Mailing Address - Country:US
Mailing Address - Phone:888-633-0086
Mailing Address - Fax:
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3718
Practice Address - Country:US
Practice Address - Phone:541-686-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069315Medicaid
292798001OtherGROUP HEALTH
8922949OtherWASHINGTON CRIME VICTIMS
057221000OtherBLUE CROSS
OR168123Medicaid
379423200OtherUS DEPT OF LABOR
76160OtherWASHINGTON L&I
DZ4060OtherPACC
WA7107451Medicaid
DZ4060OtherPACC
8922949OtherWASHINGTON CRIME VICTIMS
DZ4060OtherPACC