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Organization
HALE2 MEN'S CLINIC, LLC
Active
Organization
HALE2 MEN'S CLINIC, LLC
Active
Other names
HALE MEN'S CLINIC, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTIAN MARTIN FERRY MD (OWNER)
(541) 228-3660
Entity
Organization
Contact information
Practice address
1410 OAK ST STE 101, EUGENE, OR 97401-4668
(541) 228-3660
(541) 228-3266
Mailing address
1410 OAK ST STE 101, EUGENE, OR 97401-4668
(541) 228-3660
(541) 228-3266
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
363L00000X
Nurse Practitioner
NP201401588
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621399
NAICS CODE
OR
01
—
9978
EFTPS
—
Enumeration date
12/21/2017
Last updated
12/21/2017
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