Provider Demographics
NPI:1659556462
Name:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Other - Org Name:GARDEN WAY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:4000 MERIDIAN BLVD
Mailing Address - Street 2:ATTN: DEBBIE BREWER
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6325
Mailing Address - Country:US
Mailing Address - Phone:615-465-7626
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:STE. 350
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-746-6816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1659556462OtherNPI
OR6067360001Medicare NSC