Organization Name: | SALEM CLINIC, PC |
NPI Number: | 1962781526 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARBARA GUNDER (ADMINISTRATOR/CAO) |
Mailing Address: | 1174 Cornucopia St Nw Ste 120 Salem |
State: | OR US |
Postal Code: | 973043193 |
Phone Number: | 5033992424 |
Fax Number: | 5033757429 |
NPI Enumeration Date: | 08/12/2011 |
NPI Last Update Date: | 08/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |