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NPI Code Detail

MEDICARE: PRIMARY CARE WEST, P.C.

MEDICARE: PRIMARY CARE WEST, P.C.
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
1261Q00000XClinic/Center13749OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407854243
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE WEST, P.C.
Provider Business Mailing Address
First Line : 1255 WALLACE RD NW
Second Line :
City : SALEM
State : OR
Zip : 97304-3007
Country : US
Telephone Number : 503-362-1314
Fax Number :
Provider Business Practice Location Address
First Line : 1255 WALLACE RD NW
Second Line :
City : SALEM
State : OR
Zip : 97304-3007
Country : US
Telephone Number : 503-362-1314
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. LORI LEANNE HOVENDEN
Credential :
Telephone Number : 503-362-1314
Provider Enumeration Date : 07/13/2005
Last Update Date : 10/21/2020

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Directions to “PRIMARY CARE WEST, P.C. ” Practice Location

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