Healthcare Provider Details

I. General information

NPI: 1578565347
Provider Name (Legal Business Name): CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA RD NE
SALEM OR
97305-1119
US

IV. Provider business mailing address

3750 CHEMAWA RD NE
SALEM OR
97305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-7600
  • Fax: 503-304-7678
Mailing address:
  • Phone: 503-304-7600
  • Fax: 503-304-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA J HERBISON
Title or Position: ACTING CHIEF EXECUTIVE OFFICER
Credential:
Phone: 503-304-7659