Provider Demographics
NPI:1871850743
Name:OREGON UNIVERSITY SYSTEM
Entity Type:Organization
Organization Name:OREGON UNIVERSITY SYSTEM
Other - Org Name:UNIVERSITY HEALTH CENTER PTSM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-346-2726
Mailing Address - Street 1:1232 UNIVERSITY OF OREGON
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1205
Mailing Address - Country:US
Mailing Address - Phone:541-346-4401
Mailing Address - Fax:541-346-2747
Practice Address - Street 1:1232 UNIVERSITY OF OREGON
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1205
Practice Address - Country:US
Practice Address - Phone:541-346-4401
Practice Address - Fax:541-346-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110148Medicaid
OR1467570077OtherPARENT ORGANIZATION NPI