Healthcare Provider Details

I. General information

NPI: 1922585314
Provider Name (Legal Business Name): OREGON MEDICAL CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 LIBERTY ST NE
SALEM OR
97301-8386
US

IV. Provider business mailing address

2515 LIBERTY ST NE
SALEM OR
97301-8386
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-1552
  • Fax:
Mailing address:
  • Phone: 503-390-1552
  • Fax: 503-393-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201804939NP-PP
License Number StateOR

VIII. Authorized Official

Name: SUNITA BHASIN
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 503-390-1552