Organization
PEACEHEALTH
Active
Other names
SOUTH LANE MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY NMI APLAND (CFO)
(541) 686-3968
Entity
Organization
Contact information
Practice address
1515 VILLAGE DR, COTTAGE GROVE, OR 97424-9700
(541) 942-0511
Mailing address
PO BOX 24410, EUGENE, OR 97402-0451
(541) 349-7683
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130008
—
OR
Enumeration date
09/15/2006
Last updated
07/12/2013
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