Provider Demographics
NPI:1558571687
Name:WILLAMETTE VALLEY ORTHOPAEDIC SURGERY
Entity type:Organization
Organization Name:WILLAMETTE VALLEY ORTHOPAEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAN PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-8162
Mailing Address - Street 1:375 SE NORTON LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8484
Mailing Address - Country:US
Mailing Address - Phone:503-472-8162
Mailing Address - Fax:503-474-9430
Practice Address - Street 1:375 SE NORTON LN
Practice Address - Street 2:SUITE C
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8484
Practice Address - Country:US
Practice Address - Phone:503-472-8162
Practice Address - Fax:503-474-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD024130302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181583Medicaid
OR114924Medicare ID - Type Unspecified
OR181583Medicaid