Provider Demographics
NPI:1972535086
Name:MCMINNVILLE IMMEDIATE HEALTH CARE LLC
Entity Type:Organization
Organization Name:MCMINNVILLE IMMEDIATE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERREL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-504-6315
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0519
Mailing Address - Country:US
Mailing Address - Phone:541-923-4576
Mailing Address - Fax:541-923-4976
Practice Address - Street 1:207 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6225
Practice Address - Country:US
Practice Address - Phone:503-435-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR132478Medicare PIN