Healthcare Provider Details

I. General information

NPI: 1790937142
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COUNTRY CLUB RD STE 200
EUGENE OR
97401-6024
US

IV. Provider business mailing address

7100 COMMERCE WAY STE 180
BRENTWOOD TN
37027-2829
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-2134
  • Fax: 541-686-6021
Mailing address:
  • Phone: 615-465-7000
  • Fax: 615-465-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1790937142
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI

VIII. Authorized Official

Name: DEBBIE BREWER
Title or Position: DIRECTOR
Credential:
Phone: 615-465-7631