Healthcare Provider Details

I. General information

NPI: 1134152374
Provider Name (Legal Business Name): SALEM CARDIOVASCULAR ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 MISSION STREET SE
SALEM OR
97302
US

IV. Provider business mailing address

885 MISSION STREET SE
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-5585
  • Fax: 503-399-1659
Mailing address:
  • Phone: 503-585-5585
  • Fax: 503-399-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES E WASENMILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 503-585-5585