Provider Demographics
NPI:1427550557
Name:WILLAMETTE VALLEY PEDIATRICS
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-513-9265
Mailing Address - Street 1:1123 HILL ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-3292
Mailing Address - Country:US
Mailing Address - Phone:541-207-7431
Mailing Address - Fax:541-644-5017
Practice Address - Street 1:1123 HILL ST SE STE B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-3292
Practice Address - Country:US
Practice Address - Phone:541-207-7431
Practice Address - Fax:541-644-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty