WILLAMETTE COMMUNITY MEDICAL GROUP, LLC (NPI# 1104062371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104062371 |
| Entity Type | Organization |
| Organization Name | WILLAMETTE COMMUNITY MEDICAL GROUP, LLC |
| Other Organization Name | OMG THURSTON MEDICAL GROUP |
| Practice Address |
5781 Main St Springfield OR 97478-5426 |
| Mailing Address |
5810 Nancy Ridge Dr 100 San Diego CA 92121-2834 |
| Practice Telephone | 5412841694 |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2008-12-18 |
| Authorized Official Name | KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | MD15590 | OR | Suppliers |
| Other Name | Type Code |
|---|---|
| OMG Thurston Medical Group | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WILLAMETTE COMMUNITY MEDICAL GROUP, LLC | 4000 Meridian Blvd, Franklin, TN 37067 |
| Street Address |
5781 MAIN ST |
| City | SPRINGFIELD |
| State | OR |
| Zip Code | 97478-5426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225014533 | Karen Poague | Physical Therapist | 5781 Main St, Springfield, OR 97478-5426 | 2005-12-19 |
| 1588042030 | Miranda Barlow | Nurse Practitioner | 5781 Main St, Springfield, OR 97478-5426 | 2015-05-15 |
| 1528356953 | Icco, LLC | Clinic/Center | 5781 Main St, Springfield, OR 97478-5426 | 2011-07-19 |
| 1285819094 | Willamette Community Medical Group | Durable Medical Equipment & Medical Supplies | 5781 Main St, Springfield, OR 97478-5426 | 2007-12-31 |
| 1306813795 | Oregon Medical Group At Thurston Physical Therapy | Physical Therapist | 5781 Main St, Springfield, OR 97478-5426 | 2006-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588225155 | Mckenzie Dental Center | Dentist | 110 S. 59th St, Springfield, OR 97478 | 2019-06-25 |
| 1831691310 | Michael Ryan Odle | Psychologist | 36716 Oak Point Rd, Springfield, OR 97478 | 2018-03-01 |
| 1639612880 | Icco LLC | Clinic/Center | 5781 Main Street, Springfield, OR 97478 | 2016-11-21 |
| 1639529258 | Nate John Sutherland | Behavioral Analyst | 37770 Upper Creek Road, Springfield, OR 97478 | 2016-06-14 |
| 1457760134 | Leah Rybolt | Physical Therapist | 145 South 52nd Place, Springfield, OR 97478 | 2014-08-07 |
| 1972918423 | Loree Lynn Howard | Case Manager/Care Coordinator | 4145 Jasper Road, Springfield, OR 97478 | 2014-06-24 |
| 1245589753 | Sarah M Boothe | Doula | 870 S 46th St, Springfield, OR 97478 | 2012-08-30 |
| 1902155401 | Dani Maree Hill | Pharmacist | 5744 Main Street, Springfield, OR 97478 | 2012-08-30 |
| 1295005312 | Express Services Unlimited, Inc. | Non-emergency Medical Transport (VAN) | 37506 Hills Creek Road, Springfield, OR 97478 | 2012-01-05 |
| 1255524468 | Leeann D Fields | Licensed Practical Nurse | 3318 Lakeview Dr, Eugene, OR 97478 | 2007-08-21 |
| Find all providers in zip 97478 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710516901 | Tennessee Oncology Pharmacy Dispensing | Non-Pharmacy Dispensing Site | 504 22nd Ave E, Springfield, TN 37172-3754 | 2020-04-08 |
| 1568945103 | Ficom | Non-Pharmacy Dispensing Site | 1308 North Glenstone Avenue, Springfield, MO 65802 | 2018-09-10 |
| 1811131956 | U.S. Optical | Non-Pharmacy Dispensing Site | 2346 S Campbell Ave, Springfield, MO 65807-2972 | 2009-04-20 |
| 1225541188 | Springfield Clinic LLP | Non-Pharmacy Dispensing Site | 2200 Wabash Ave, Springfield, IL 62704-5352 | 2017-11-14 |
| 1669985602 | Springfield Clinic LLP | Non-Pharmacy Dispensing Site | 1025 S 6th St, Springfield, IL 62703-2403 | 2017-11-13 |
| 1932511870 | Patient First Pennsylvania Medical Group | Non-Pharmacy Dispensing Site | 417 Baltimore Pike, Springfield, PA 19064-3810 | 2014-05-27 |
| 1659713345 | Peace Health | Non-Pharmacy Dispensing Site | 3333 Riverbend Dr, Springfield, OR 97477-8800 | 2013-07-23 |
| 1225473770 | Mayo Clinic Health System-southwest Minnesota Region | Non-Pharmacy Dispensing Site | 625 N Jackson Ave, Springfield, MN 56087-1714 | 2013-05-09 |
| 1528388485 | Springfield Health Care Center, Inc. | Non-Pharmacy Dispensing Site | 2624 Lexington Ave, 200, Springfield, OH 45505-2607 | 2010-06-02 |
| 1023069473 | Planned Parenthood League of Ma | Non-Pharmacy Dispensing Site | Karen Loeb Lifford Md, 3550 Main St Ste 201, Springfield, MA 01107 | 2006-05-12 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 97478 |
Please comment or provide details below to improve the information on WILLAMETTE COMMUNITY MEDICAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.