| Prov Peds Neurology Salem | |
|
2478 13th St Se Salem OR 97302-2522 | |
| (503) 362-2481 | |
| Not Available |
| Full Name | Prov Peds Neurology Salem |
|---|---|
| Speciality | Clinic/center |
| Location | 2478 13th St Se, Salem, Oregon |
| Authorized Official Name and Position | Keenan B Freeman (CFO) |
| Authorized Official Contact | 5038936524 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prov Peds Neurology Salem Po Box 3158 Portland OR 97208-3158 Ph: (503) 215-6494 | Prov Peds Neurology Salem 2478 13th St Se Salem OR 97302-2522 Ph: (503) 362-2481 |
| NPI Number | 1689845489 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 12/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689845489 | NPI | - | NPPES |
| 279131 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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