| Clinical Support Providers | |
|
2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 | |
| (503) 587-5116 | |
| (503) 581-7422 |
| Full Name | Clinical Support Providers |
|---|---|
| Speciality | Clinic/Center |
| Location | 2995 Ryan Dr Se Ste 200, Salem, Oregon |
| Authorized Official Name and Position | Manuel Rivera (CEO) |
| Authorized Official Contact | 5035875116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Support Providers 2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 Ph: (503) 371-7701 | Clinical Support Providers 2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 Ph: (503) 587-5116 |
| NPI Number | 1922583616 |
|---|---|
| Provider Enumeration Date | 09/27/2018 |
| Last Update Date | 03/12/2024 |
| Medicare PECOS PAC ID | 4486627965 |
|---|---|
| Medicare Enrollment ID | O20200901001891 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922583616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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