Provider Demographics
NPI:1366105199
Name:LONEROCK CLINIC LLC
Entity type:Organization
Organization Name:LONEROCK CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PINCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:208-720-3948
Mailing Address - Street 1:360 E 10TH AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3687
Mailing Address - Country:US
Mailing Address - Phone:833-646-3633
Mailing Address - Fax:971-261-1705
Practice Address - Street 1:360 E 10TH AVE STE 308
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3273
Practice Address - Country:US
Practice Address - Phone:208-720-3948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1710406012OtherNPI