Provider Demographics
NPI:1568413573
Name:MCKENZIE-WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC
Entity Type:Organization
Organization Name:MCKENZIE-WILLAMETTE REGIONAL MEDICAL CENTER ASSOCIATES LLC
Other - Org Name:MCKENZIE-WILLAMETTE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYS SERVICES FINANCIAL OPS/AO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:1460 G ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4112
Mailing Address - Country:US
Mailing Address - Phone:541-726-4401
Mailing Address - Fax:541-726-4540
Practice Address - Street 1:1460 G ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4112
Practice Address - Country:US
Practice Address - Phone:541-726-4401
Practice Address - Fax:541-726-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
OR394902282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232828Medicaid
OR232828Medicaid