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
—
—
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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