Provider Demographics
NPI:1801812078
Name:OREGON UROLOGY INSTITUTE PC
Entity type:Organization
Organization Name:OREGON UROLOGY INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEHLHAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-334-3350
Mailing Address - Street 1:2400 HARTMAN LN STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1122
Mailing Address - Country:US
Mailing Address - Phone:541-334-3350
Mailing Address - Fax:541-284-5198
Practice Address - Street 1:2400 HARTMAN LN STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1122
Practice Address - Country:US
Practice Address - Phone:541-334-3350
Practice Address - Fax:541-284-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0307610001Medicare NSC
ORR0000WCGLRMedicare PIN