Provider Demographics
NPI:1770944506
Name:INTEGRATED HEALTH MANAGEMENT
Entity type:Organization
Organization Name:INTEGRATED HEALTH MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-353-9415
Mailing Address - Street 1:715 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2502
Mailing Address - Country:US
Mailing Address - Phone:541-344-3574
Mailing Address - Fax:541-344-5652
Practice Address - Street 1:715 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2502
Practice Address - Country:US
Practice Address - Phone:541-344-3574
Practice Address - Fax:541-344-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR-10041-M251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230475Medicaid