Healthcare Provider Details

I. General information

NPI: 1447834064
Provider Name (Legal Business Name): ARETE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MILLER ST SE STE 200
SALEM OR
97302-4272
US

IV. Provider business mailing address

350 MILLER ST SE STE 200
SALEM OR
97302-4272
US

V. Phone/Fax

Practice location:
  • Phone: 503-400-3434
  • Fax:
Mailing address:
  • Phone: 503-400-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENNAYA LYNN MATTISON
Title or Position: OWNER
Credential: M.D.
Phone: 503-400-3434