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360 E 10th Ave Ste 308 Eugene OR 97401-3273 | |
| (208) 720-3948 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 360 E 10th Ave Ste 308, Eugene, Oregon |
| Authorized Official Name and Position | Camille Ellen Pincock (OWNER) |
| Authorized Official Contact | 2087203948 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1307 Lincoln St Eugene OR 97401-3978 Ph: (833) 646-3633 | 360 E 10th Ave Ste 308 Eugene OR 97401-3273 Ph: (208) 720-3948 |
| NPI Number | 1366105199 |
|---|---|
| Provider Enumeration Date | 10/19/2021 |
| Last Update Date | 12/18/2024 |
| Medicare PECOS PAC ID | 7810386398 |
|---|---|
| Medicare Enrollment ID | O20211123001437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366105199 | NPI | - | NPPES |
| 1710406012 | Other | OR | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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