Provider Demographics
NPI:1609574839
Name:WILLAMETTE VALLEY MEDICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY MEDICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:503-436-6994
Mailing Address - Street 1:6250 COMMERCIAL ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2988
Mailing Address - Country:US
Mailing Address - Phone:503-436-6994
Mailing Address - Fax:715-504-8646
Practice Address - Street 1:6250 COMMERCIAL ST SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2988
Practice Address - Country:US
Practice Address - Phone:503-436-6994
Practice Address - Fax:715-504-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725506Medicaid