Provider Demographics
NPI:1215647029
Name:EHG OF OREGON PC
Entity type:Organization
Organization Name:EHG OF OREGON PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-240-3770
Mailing Address - Street 1:1A BURTON HILLS BOULEVARD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-263-5576
Mailing Address - Fax:615-490-0121
Practice Address - Street 1:1715 SW CHANDLER AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3615
Practice Address - Country:US
Practice Address - Phone:541-550-7223
Practice Address - Fax:541-550-7224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EHG OF OREGON PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty