# PEACEHEALTH MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447207287
- **Authorized official:** LORI KETTLER (PROVIDER ENROLLMENT LEAD)
- **Authorized official phone:** (360) 729-1411

## Contact information

- **Practice address:** 1200 HILYARD ST, EUGENE, OR 97401-8122
- **Practice address phone:** (541) 687-6217
- **Mailing address:** PO BOX 24410, EUGENE, OR 97402-0451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | OR | Yes |
| 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