Organization
PEACEHEALTH
Active
Parent organization
PEACEHEALTH
Other names
PEACEHEALTH MEDICAL GROUP-DEXTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEACEHEALTH
Authorized official
WENDY APLAND (CFO)
(541) 686-3968
Entity
Organization
Contact information
Practice address
38843 DEXTER RD, DEXTER, OR 97431-0110
(541) 937-2134
Mailing address
PO BOX 24410, EUGENE, OR 97402-0451
(541) 984-4301
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38 3808
MEDICARE PART A PTAN
—
Enumeration date
02/17/2010
Last updated
09/10/2010
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