Provider Demographics
NPI:1720157597
Name:MCKENZIE FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:MCKENZIE FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-344-8225
Mailing Address - Street 1:1755 COBURG RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4984
Mailing Address - Country:US
Mailing Address - Phone:541-344-8225
Mailing Address - Fax:541-744-7322
Practice Address - Street 1:1755 COBURG RD STE 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4984
Practice Address - Country:US
Practice Address - Phone:541-344-8225
Practice Address - Fax:541-744-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151025Medicaid
OR38DO857081OtherCLIA
OR151025Medicaid