Healthcare Provider Details

I. General information

NPI: 1457536260
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N 19TH ST
SPRINGFIELD OR
97477-2526
US

IV. Provider business mailing address

4000 MERIDIAN BLVD ATTN: DEBBIE BREWER
FRANKLIN TN
37067-6325
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-5437
  • Fax: 541-746-3753
Mailing address:
  • Phone: 615-465-7626
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE BREWER
Title or Position: DIRECTOR
Credential:
Phone: 615-465-7626