NPIMap

Organization Active NPI

Peacehealth Medical Group

Doing business as South Clinic

  • Durable Medical Equipment & Medical Supplies
  • Eugene, OR
National Provider Identifier
1558475905
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1042230005 Issued in OR
Legal business name
PEACEHEALTH MEDICAL GROUP
Doing business as
South Clinic
Practice address
3299 Hilyard St
Eugene, OR 97405-3721
Phone
(541) 687-6016
NPI assigned
Aug 19, 2006
Last updated
Jan 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wendy Apland
Title
Cfo
Phone
(541) 686-3968

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1042230005 OR Primary

Addresses

Primary practice location

3299 Hilyard St
Eugene, OR 97405-3721

Mailing address

PO Box 24410
Eugene, OR 97402-0451
Phone (541) 349-7683

Other identifiers 2

IdentifierTypeStateIssuer
071634MedicaidOR
1042230005OtherORDME LICENSE NUMBER

Other names 1

  • SOUTH CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peacehealth Medical Group11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1558475905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451",
            "telephone_number": "541-349-7683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3299 HILYARD ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053721",
            "telephone_number": "541-687-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACEHEALTH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "APLAND",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "541-686-3968"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OR",
            "license": "1042230005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071634",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME LICENSE NUMBER",
            "identifier": "1042230005",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.