Healthcare Provider Details

I. General information

NPI: 1033926167
Provider Name (Legal Business Name): MCKENZIE WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 G ST
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

1573 MALLORY LN
BRENTWOOD TN
37027-2895
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA J FEY
Title or Position: VP PHYSICIAN SERVICES FINANCIAL OPS
Credential:
Phone: 615-221-3641