Provider Demographics
NPI:1881621381
Name:LINTZ, JAN K (PA)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:K
Last Name:LINTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 HILYARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3866
Mailing Address - Country:US
Mailing Address - Phone:541-687-8581
Mailing Address - Fax:541-343-1411
Practice Address - Street 1:3525 HILYARD ST STE 600
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3866
Practice Address - Country:US
Practice Address - Phone:541-687-8581
Practice Address - Fax:541-343-1411
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT280363A00000X
ORPA01323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000095553OtherBCBS PROV NUMBER
MT000085098Medicare ID - Type UnspecifiedPA MEDICARE PROV #
MTP62655Medicare UPIN