Healthcare Provider Details

I. General information

NPI: 1114197894
Provider Name (Legal Business Name): SALEM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 WINTER ST SE FAMILY BIRTH CENTER 3RD FLOOR NEONATAL INTENSIVE CARE
SALEM OR
97301-3919
US

IV. Provider business mailing address

2173 LAURINE CT NE
SALEM OR
97301-4432
US

V. Phone/Fax

Practice location:
  • Phone: 503-562-5660
  • Fax:
Mailing address:
  • Phone: 541-913-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateOR

VIII. Authorized Official

Name: MS. LAURA LEE KELLENBARGER
Title or Position: NEONATAL NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 503-562-5654