| Primary Care West, P.c. | |
|
1255 Wallace Rd Nw Salem OR 97304-3007 | |
| (503) 362-1314 | |
| Not Available |
| Full Name | Primary Care West, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1255 Wallace Rd Nw, Salem, Oregon |
| Authorized Official Name and Position | Lori Leanne Hovenden (OFFICE MANAGER) |
| Authorized Official Contact | 5033621314 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care West, P.c. 1255 Wallace Rd Nw Salem OR 97304-3007 Ph: (503) 362-1314 | Primary Care West, P.c. 1255 Wallace Rd Nw Salem OR 97304-3007 Ph: (503) 362-1314 |
| NPI Number | 1407854243 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 10/21/2020 |
| Medicare PECOS PAC ID | 7416946348 |
|---|---|
| Medicare Enrollment ID | O20040507000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407854243 | NPI | - | NPPES |
| 278804 | Medicaid | OR | |
| 021159 | Medicaid | OR | |
| 019179 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 13749 (Oregon) | Primary |
| Provider Name | Katie Ester Tihanyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467440321 PECOS PAC ID: 2264557727 Enrollment ID: I20100921000740 |
| Provider Name | Laslo E Kolta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558359406 PECOS PAC ID: 1052300985 Enrollment ID: I20100921000798 |
| Provider Name | Alana Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447594965 PECOS PAC ID: 3971756594 Enrollment ID: I20130128000465 |
| Provider Name | Serena Dawn Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790117257 PECOS PAC ID: 0042529687 Enrollment ID: I20151021001131 |
| Provider Name | Susan Elisabeth Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932651007 PECOS PAC ID: 6507146644 Enrollment ID: I20161207002562 |
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