Healthcare Provider Details

I. General information

NPI: 1124579479
Provider Name (Legal Business Name): WILLAMETTE VALLEY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

103 CONTINENTAL PL STE 200
BRENTWOOD TN
37027-1041
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-6320
  • Fax: 503-472-8691
Mailing address:
  • Phone: 615-844-9800
  • Fax: 615-844-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE DILLON
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7220