1427266246 NPI number — WILLAMETTE FALLS HOSPITAL

Table of content: (NPI 1427266246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427266246 NPI number — WILLAMETTE FALLS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAMETTE FALLS HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUNNYSIDE INTERNAL MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427266246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 DIVISION ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045-1599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-650-6880
Provider Business Mailing Address Fax Number:
503-650-6888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9755 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
STE 800
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-6784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-654-2364
Provider Business Practice Location Address Fax Number:
503-786-1524
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLOMQUIST
Authorized Official First Name:
TROY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
503-557-2917

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com