OrganizationActive
Willamette Community Medical Group, LLC
NPI 1104062371 · Non-Pharmacy Dispensing Site · Springfield, OR
Provider details
- NPI number
- 1104062371
- Entity type
- Organization
- Primary specialty
- Non-Pharmacy Dispensing SiteSuppliers
- Parent organization
- Medvantx, Inc.
- Organization subpart
- Yes
- Authorized official
- Kenny Heine, Director of Operations(858) 625-2990
- License
- MD15590 (OR)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(86/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5781 Main St
Springfield, OR 97478-5426
Phone: (541) 284-1694
Street-level locationGet directions
Mailing address
5810 Nancy Ridge Dr
San Diego, CA 92121-2834
Other names (DBA / former)
- Doing business as
- Omg Thurston Medical Group
Registry dates
- Enumerated
- 2008-12-18
- Last updated
- 2008-12-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.