Provider Demographics
NPI:1548681844
Name:MCMINNVILLE FREE CLINIC
Entity type:Organization
Organization Name:MCMINNVILLE FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUI
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRILL COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-474-3600
Mailing Address - Street 1:2155 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-731-5146
Practice Address - Street 1:125 SE COWLS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6005
Practice Address - Country:US
Practice Address - Phone:503-560-8334
Practice Address - Fax:866-731-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center