Healthcare Provider Details

I. General information

NPI: 1093828006
Provider Name (Legal Business Name): SILVERTON HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 WELCH ST
SILVERTON OR
97381
US

IV. Provider business mailing address

PO BOX 3417
PORTLAND OR
97208-3417
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-1722
  • Fax: 503-874-2470
Mailing address:
  • Phone: 503-873-1500
  • Fax: 503-873-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD25349
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD16538
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD24813
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD25866
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number200550137NP
License Number StateOR

VIII. Authorized Official

Name: SARAH JENSEN
Title or Position: INTERIM CFO
Credential:
Phone: 503-415-5145