Provider Demographics
NPI:1730797762
Name:WILLAMETTE FOOT CENTER INC
Entity type:Organization
Organization Name:WILLAMETTE FOOT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-363-0763
Mailing Address - Street 1:4305 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5506
Mailing Address - Country:US
Mailing Address - Phone:503-363-0763
Mailing Address - Fax:503-363-8154
Practice Address - Street 1:4305 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5506
Practice Address - Country:US
Practice Address - Phone:503-363-0763
Practice Address - Fax:503-363-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR295456Medicaid