Healthcare Provider Details

I. General information

NPI: 1427266246
Provider Name (Legal Business Name): WILLAMETTE FALLS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 SE SUNNYSIDE RD STE 800
CLACKAMAS OR
97015-6784
US

IV. Provider business mailing address

1510 DIVISION ST STE 200
OREGON CITY OR
97045-1599
US

V. Phone/Fax

Practice location:
  • Phone: 503-654-2364
  • Fax: 503-786-1524
Mailing address:
  • Phone: 503-650-6880
  • Fax: 503-650-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TROY L BLOMQUIST
Title or Position: DIRECTOR
Credential:
Phone: 503-557-2917