Provider Demographics
NPI:1780809103
Name:TERRANCE A HILL MD PC
Entity type:Organization
Organization Name:TERRANCE A HILL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-451-6397
Mailing Address - Street 1:55D TWIN OAKS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2851
Mailing Address - Country:US
Mailing Address - Phone:541-451-6397
Mailing Address - Fax:541-451-6397
Practice Address - Street 1:55D TWIN OAKS AVE STE 2
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2851
Practice Address - Country:US
Practice Address - Phone:541-451-6397
Practice Address - Fax:541-451-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13085207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR260992Medicaid
OR260992Medicaid