Healthcare Provider Details

I. General information

NPI: 1245441849
Provider Name (Legal Business Name): MR. RICHARD A HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 NE HIGHWAY 20
CORVALLIS OR
97330-9695
US

IV. Provider business mailing address

29538 NE PHEASANT AVE
CORVALLIS OR
97333-2431
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-7722
  • Fax:
Mailing address:
  • Phone: 541-754-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5412078
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: