Healthcare Provider Details

I. General information

NPI: 1861556920
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: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA RD NE CHEMAWA INDIAN HEALTH CENTER WESTERN OREGON SERVICE UNI
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 Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License NumberAP8985218
License Number StateDC

VIII. Authorized Official

Name: MR. ADAM THOMAS BIRDINGROUND
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 503-304-7642