Healthcare Provider Details

I. General information

NPI: 1619933264
Provider Name (Legal Business Name): SALEM SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2006
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 12ST SE SUITE 110
SALEM OR
97302
US

IV. Provider business mailing address

2525 12TH STREET SE SUITE 110
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-3704
  • Fax:
Mailing address:
  • Phone: 503-364-3704
  • Fax: 503-364-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MEGAN JACKSON
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 503-364-3704