Provider Demographics
NPI:1356716377
Name:WILSONVILLE HEALTHCARE LLC
Entity type:Organization
Organization Name:WILSONVILLE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHIERHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-998-8755
Mailing Address - Street 1:29702 SW TOWN CENTER LOOP W
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6481
Mailing Address - Country:US
Mailing Address - Phone:503-482-5570
Mailing Address - Fax:503-855-3058
Practice Address - Street 1:29702 SW TOWN CENTER LOOP W
Practice Address - Street 2:SUITE C
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6481
Practice Address - Country:US
Practice Address - Phone:503-482-5570
Practice Address - Fax:503-855-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500696731Medicaid