Provider Demographics
NPI:1477740710
Name:MCMINNVILLE OBSTETRICS & GYNECOLOGY LLC
Entity Type:Organization
Organization Name:MCMINNVILLE OBSTETRICS & GYNECOLOGY LLC
Other - Org Name:GEORGE T BARKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-3167
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0088
Mailing Address - Country:US
Mailing Address - Phone:503-472-3167
Mailing Address - Fax:503-434-5335
Practice Address - Street 1:320 SE BAKER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6038
Practice Address - Country:US
Practice Address - Phone:503-472-3167
Practice Address - Fax:503-434-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13374207V00000X
OR084058508367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR032313Medicaid
ORR117316Medicare PIN