Healthcare Provider Details

I. General information

NPI: 1811981020
Provider Name (Legal Business Name): JEFFREY F JARVI PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2478 13TH ST SE
SALEM OR
97302-2546
US

IV. Provider business mailing address

2478 13TH ST SE
SALEM OR
97302-2546
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-2481
  • Fax: 503-371-7803
Mailing address:
  • Phone: 503-362-2481
  • Fax: 503-371-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00423
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberPA00423
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: