| White Bird Clinic | |
|
341 E 12th Ave Eugene OR 97401-3212 | |
| (541) 342-8255 | |
| (541) 342-7987 |
| Full Name | White Bird Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 341 E 12th Ave, Eugene, Oregon |
| Authorized Official Name and Position | Benjamin I Brubaker (CLINIC COORDINATOR) |
| Authorized Official Contact | 5413428255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Bird Clinic 341 E 12th Ave Eugene OR 97401-3212 Ph: (541) 342-8255 | White Bird Clinic 341 E 12th Ave Eugene OR 97401-3212 Ph: (541) 342-8255 |
| NPI Number | 1598000960 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 06/28/2019 |
| Medicare PECOS PAC ID | 3678554060 |
|---|---|
| Medicare Enrollment ID | O20040601000678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598000960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Gary E Brandt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871571703 PECOS PAC ID: 2264536606 Enrollment ID: I20070326000013 |
| Provider Name | Kimberly A Cotton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194757385 PECOS PAC ID: 5193768588 Enrollment ID: I20180501000811 |
| Provider Name | Dana L Omary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932612355 PECOS PAC ID: 0143575902 Enrollment ID: I20180619001548 |
| Provider Name | Lindsey M Adkisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386266450 PECOS PAC ID: 1355755398 Enrollment ID: I20210202002152 |
| Provider Name | Lawrence Lyon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467653766 PECOS PAC ID: 6406074749 Enrollment ID: I20230222002085 |
| Provider Name | Margaret M Ackerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972723906 PECOS PAC ID: 9133193451 Enrollment ID: I20230306001782 |
| Provider Name | Todd Infinger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336730084 PECOS PAC ID: 2769899012 Enrollment ID: I20240108006107 |
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