MEDICARE: SAINT MOSCATI COMMUNITY HEALTH CARE

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	261Q00000X	Clinic/Center	201600993NP-PP	OR
2	261QP2300X	Primary Care Clinic/Center

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	:	1326589771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT MOSCATI COMMUNITY HEALTH CARE

Provider Business Mailing Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:	503-961-0794

Provider Business Practice Location Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:	503-961-0794

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	CLARA CASTILLO
Credential	:
Telephone Number	:	971-273-0679

Provider Enumeration Date	:	03/18/2017
Last Update Date	:	04/04/2024

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Directions to “SAINT MOSCATI COMMUNITY HEALTH CARE ” Practice Location

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