NPI 1104062371

Willamette Community Medical Group, LLC

Organisation Non-Pharmacy Dispensing Site Springfield, OR

Practice location

Address: 5781 Main St, Springfield, OR 97478-5426
Phone: (541) 284-1694
Mailing address: 5810 Nancy Ridge Dr 100, San Diego, CA 92121-2834

Authorised official

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

Registered specialties

Non-Pharmacy Dispensing Site Primary

Suppliers Taxonomy 332900000X Licence MD15590 (OR)

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Registry record

NPI: 1104062371
Entity type: Organization
NPI issued: 18 Dec 2008
Record last updated: 18 Dec 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.