Healthcare Provider Details

I. General information

NPI: 1003623224
Provider Name (Legal Business Name): ALANTE PRIMARY CARE O LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 20TH ST SE STE 310
SALEM OR
97302-2400
US

IV. Provider business mailing address

1220 20TH ST SE
SALEM OR
97302-1798
US

V. Phone/Fax

Practice location:
  • Phone: 480-631-4978
  • Fax: 844-443-4378
Mailing address:
  • Phone: 480-631-4978
  • Fax: 844-443-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACOB SCHAEFER
Title or Position: CFO
Credential:
Phone: 503-201-8356