Healthcare Provider Details

I. General information

NPI: 1528006301
Provider Name (Legal Business Name): MCKENZIE WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 G ST
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

1460 G ST
SPRINGFIELD OR
97477-4112
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-4401
  • Fax: 541-726-4540
Mailing address:
  • Phone: 541-726-4401
  • Fax: 541-726-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: REBECCA HURLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 214-473-7000