Provider Demographics
NPI:1962216689
Name:PERIGON MEDICAL CLINIC
Entity type:Organization
Organization Name:PERIGON MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:AULD
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:541-799-6279
Mailing Address - Street 1:1400 VALLEY RIVER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6759
Mailing Address - Country:US
Mailing Address - Phone:541-799-6279
Mailing Address - Fax:
Practice Address - Street 1:1400 VALLEY RIVER DR STE 220
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6759
Practice Address - Country:US
Practice Address - Phone:541-799-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty