Healthcare Provider Details

I. General information

NPI: 1972535086
Provider Name (Legal Business Name): MCMINNVILLE IMMEDIATE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 NE 19TH ST
MCMINNVILLE OR
97128-6225
US

IV. Provider business mailing address

PO BOX 1770
REDMOND OR
97756-0519
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-1077
  • Fax:
Mailing address:
  • Phone: 541-923-4576
  • Fax: 541-923-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERREL ANN STEPHENS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 541-504-6315