MEDICARE: MCKENZIE-WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center
2	282N00000X	General Acute Care Hospital	394902	OR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1568413573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKENZIE-WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1460 G ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4112
Country	:	US
Telephone Number	:	541-726-4401
Fax Number	:	541-726-4540

Provider Business Practice Location Address
First Line	:	1460 G ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4112
Country	:	US
Telephone Number	:	541-726-4401
Fax Number	:	541-726-4540

Authorized Official
Title or Position	:	VP PHYS SERVICES FINANCIAL OPS/AO
Name	:	LAURA FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/22/2024

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039