| Lancaster Medical At Lancaster | |
|
255 Lancaster Dr Ne Salem OR 97301-5155 | |
| (503) 576-8400 | |
| Not Available |
| Full Name | Lancaster Medical At Lancaster |
|---|---|
| Speciality | Clinic/Center |
| Location | 255 Lancaster Dr Ne, Salem, Oregon |
| Authorized Official Name and Position | Juan C Olivares (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5098656175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lancaster Medical At Lancaster Po Box 190 Toppenish WA 98948-0190 Ph: (509) 865-6175 | Lancaster Medical At Lancaster 255 Lancaster Dr Ne Salem OR 97301-5155 Ph: (503) 576-8400 |
| NPI Number | 1255877858 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 01/06/2017 |
| Medicare PECOS PAC ID | 4385541986 |
|---|---|
| Medicare Enrollment ID | O20170310001675 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255877858 | NPI | - | NPPES |
| 022793 | Medicaid | OR | |
| 1256764-95 | Other | OR | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1265764-95 (Oregon) | Primary |
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