MEDICARE: SALEM RHEUMATOLOGY, LLC

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	207RR0500X	Rheumatology Physician	MD153975	OR

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	:	1215218789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM RHEUMATOLOGY, LLC

Provider Business Mailing Address
First Line	:	960 LIBERTY ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4195
Country	:	US
Telephone Number	:	503-399-0652
Fax Number	:	503-373-3852

Provider Business Practice Location Address
First Line	:	960 LIBERTY ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4195
Country	:	US
Telephone Number	:	503-399-0652
Fax Number	:	503-373-3852

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	REBECCA R CALLIS
Credential	:	MD
Telephone Number	:	503-399-0652

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	12/16/2011

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Directions to “SALEM RHEUMATOLOGY, LLC ” Practice Location

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