Basic Information
Provider Information | |||||||||
NPI: | 1578111399 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PRAXIS HEALTH, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | EUGENE ENDOCRINOLOGY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1517 | ||||||||
Address2: |   | ||||||||
City: | PENDLETON | ||||||||
State: | OR | ||||||||
PostalCode: | 978010410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8777081119 | ||||||||
FaxNumber: | 5412788349 | ||||||||
Practice Location | |||||||||
Address1: | 10 COBURG RD. | ||||||||
Address2: | SUITE 201 | ||||||||
City: | EUGENE | ||||||||
State: | OR | ||||||||
PostalCode: | 974017487 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5414853636 | ||||||||
FaxNumber: | 5413444305 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/27/2019 | ||||||||
LastUpdateDate: | 08/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | REAGAN | ||||||||
AuthorizedOfficialFirstName: | JESSICA | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5419666136 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 130225 | 05 | OR |   | MEDICAID |