Provider Demographics
NPI:1790937142
Name:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Other - Org Name:ADULT MEDICINE
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:615-465-7631
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:STE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:615-465-3017
Practice Address - Street 1:920 COUNTRY CLUB RD
Practice Address - Street 2:STE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6024
Practice Address - Country:US
Practice Address - Phone:541-342-2134
Practice Address - Fax:541-686-6021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLAMETTE COMMUNITY MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1790937142OtherNPI
OR6067360006Medicare NSC