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Organization
PEACEHEALTH MEDICAL GROUP
Active
Organization
PEACEHEALTH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI KETTLER (PROVIDER ENROLLMENT LEAD)
(360) 729-1411
Entity
Organization
Contact information
Practice address
1200 HILYARD ST, EUGENE, OR 97401-8122
(541) 687-6217
Mailing address
PO BOX 24410, EUGENE, OR 97402-0451
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
103T00000X
Psychologist
—
OR
104100000X
Social Worker
—
OR
1041C0700X
Clinical Social Worker
—
OR
106H00000X
Marriage & Family Therapist
—
OR
133V00000X
Registered Dietitian
—
OR
207Q00000X
Family Medicine Physician
Primary
—
OR
207R00000X
Internal Medicine Physician
—
OR
208000000X
Pediatrics Physician
—
OK
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
OR
2084P0800X
Psychiatry Physician
—
OR
208600000X
Surgery Physician
—
OR
261QM1300X
Multi-Specialty Clinic/Center
—
OR
291U00000X
Clinical Medical Laboratory
—
NULL
367A00000X
Advanced Practice Midwife
—
OR
Other
Enumeration date
05/27/2006
Last updated
02/13/2026
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