Provider Demographics
NPI:1073548582
Name:WILLAMETTE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:WILLAMETTE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-740-3341
Mailing Address - Street 1:6029 SW GRAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3957
Mailing Address - Country:US
Mailing Address - Phone:541-740-3341
Mailing Address - Fax:
Practice Address - Street 1:6029 SW GRAND OAKS DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-3957
Practice Address - Country:US
Practice Address - Phone:541-740-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR17598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269638Medicaid
OR269638Medicaid