Provider Demographics
NPI:1912115478
Name:KEIPERSPINE, PC
Entity Type:Organization
Organization Name:KEIPERSPINE, PC
Other - Org Name:SPINE & BRAN CENTER OF EUGENE, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:EVALYN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA, CASC
Authorized Official - Phone:541-228-3660
Mailing Address - Street 1:1410 OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4604
Mailing Address - Country:US
Mailing Address - Phone:541-228-3660
Mailing Address - Fax:541-228-3670
Practice Address - Street 1:1410 OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4604
Practice Address - Country:US
Practice Address - Phone:541-485-2357
Practice Address - Fax:541-485-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130608Medicare PIN