MEDICARE: WILLAMETTE VALLEY ORTHOPAEDIC SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	MD024130	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558571687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLAMETTE VALLEY ORTHOPAEDIC SURGERY

Provider Business Mailing Address
First Line	:	375 SE NORTON LN
Second Line	:	SUITE C
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8484
Country	:	US
Telephone Number	:	503-472-8162
Fax Number	:	503-474-9430

Provider Business Practice Location Address
First Line	:	375 SE NORTON LN
Second Line	:	SUITE C
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8484
Country	:	US
Telephone Number	:	503-472-8162
Fax Number	:	503-474-9430

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. PETER K VAN PATTEN
Credential	:	MD
Telephone Number	:	503-472-8162

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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Directions to “WILLAMETTE VALLEY ORTHOPAEDIC SURGERY ” Practice Location

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