MEDICARE: WILLAMETTE FAMILY MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043483886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLAMETTE FAMILY MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	755 MEDICAL CENTER DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-2762
Country	:	US
Telephone Number	:	503-585-6388
Fax Number	:	503-485-3951

Provider Business Practice Location Address
First Line	:	304 N MAIN ST
Second Line	:
City	:	FALLS CITY
State	:	OR
Zip	:	97344-9793
Country	:	US
Telephone Number	:	503-787-3353
Fax Number	:	503-787-2911

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT STEELE
Credential	:
Telephone Number	:	503-585-6388

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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