MEDICARE: CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT

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	261QM1300X	Multi-Specialty 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	:	1578565347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT

Provider Business Mailing Address
First Line	:	3750 CHEMAWA RD NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1119
Country	:	US
Telephone Number	:	503-304-7600
Fax Number	:	503-304-7678

Provider Business Practice Location Address
First Line	:	3750 CHEMAWA RD NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1119
Country	:	US
Telephone Number	:	503-304-7600
Fax Number	:	503-304-7678

Authorized Official
Title or Position	:	ACTING CHIEF EXECUTIVE OFFICER
Name	:	MRS. LAURA J HERBISON
Credential	:
Telephone Number	:	503-304-7659

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/08/2014

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