Provider Demographics
NPI:1457764920
Name:LANE COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:LANE COMMUNITY COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:541-228-4013
Mailing Address - Street 1:PO BOX 2847
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0327
Mailing Address - Country:US
Mailing Address - Phone:541-817-2901
Mailing Address - Fax:
Practice Address - Street 1:4000 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-0640
Practice Address - Country:US
Practice Address - Phone:541-463-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2305261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental