Healthcare Provider Details

I. General information

NPI: 1447345152
Provider Name (Legal Business Name): MCMINNVILLE EAR NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE SUITE 401
MCMINNVILLE OR
97128-6258
US

IV. Provider business mailing address

2700 SE STRATUS AVE SUITE 401
MCMINNVILLE OR
97128-6258
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-7621
  • Fax:
Mailing address:
  • Phone: 503-472-7621
  • Fax: 503-434-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberHAS-P-937302
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number21518
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD19690
License Number StateOR

VIII. Authorized Official

Name: JOHN W TOPPING IX
Title or Position: PRESIDENT
Credential: MD
Phone: 503-472-7621