NPIMap

Organization Active NPI

Willamette Community Medical Group, LLC

  • Non-Pharmacy Dispensing Site
  • Springfield, OR
National Provider Identifier
1104062371
Registry record updated Dec 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
MD15590 Issued in OR
Legal business name
WILLAMETTE COMMUNITY MEDICAL GROUP, LLC
Practice address
5781 Main St
Springfield, OR 97478-5426
Phone
(541) 284-1694
NPI assigned
Dec 18, 2008
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X MD15590 OR Primary

Addresses

Primary practice location

5781 Main St
Springfield, OR 97478-5426

Mailing address

5810 Nancy Ridge Dr
100
San Diego, CA 92121-2834

Other names 1

  • OMG Thurston Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Willamette Comm Med GRP LLC5 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229558400000",
    "number": "1104062371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "address_2": "100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5781 MAIN ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974785426",
            "telephone_number": "541-284-1694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE COMMUNITY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-12-18",
        "last_updated": "2008-12-18",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "OR",
            "license": "MD15590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OMG Thurston Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.