Active NPI
Kelsi Tidball
- Specialist
- Eugene, OR
National Provider Identifier
1093121014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 16665
- Practice address
- 1310 Coburg Rd Ste 5
Eugene, OR 97401-5200 - Phone
- (541) 345-7532
- Fax
- (541) 345-6692
- NPI assigned
- Jul 10, 2014
- Last updated
- Jul 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 16665 | OR | Primary |
Addresses
Primary practice location
1310 Coburg Rd Ste 5
Eugene, OR 97401-5200
Mailing address
1310 Coburg Rd Ste 5
Eugene, OR 97401-5200
Phone (541) 345-7532
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16665 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404950400000",
"number": "1093121014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 COBURG RD STE 5",
"city": "EUGENE",
"state": "OR",
"postal_code": "974015200",
"telephone_number": "541-345-7532",
"fax_number": "541-345-6692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 COBURG RD STE 5",
"city": "EUGENE",
"state": "OR",
"postal_code": "974015200",
"telephone_number": "541-345-7532",
"fax_number": "541-345-6692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDBALL",
"first_name": "KELSI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-10",
"last_updated": "2014-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "16665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.