Provider Demographics
NPI:1407063597
Name:WILLAMETTE FALLS HOSPITAL
Entity Type:Organization
Organization Name:WILLAMETTE FALLS HOSPITAL
Other - Org Name:WEST LINN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:506-557-2917
Mailing Address - Street 1:1510 DIVISION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1599
Mailing Address - Country:US
Mailing Address - Phone:503-650-6880
Mailing Address - Fax:503-650-6888
Practice Address - Street 1:18676 WILLAMETTE DR STE 100
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1718
Practice Address - Country:US
Practice Address - Phone:503-635-6430
Practice Address - Fax:503-635-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000WFBWRMedicare ID - Type Unspecified