Healthcare Provider Details

I. General information

NPI: 1992420194
Provider Name (Legal Business Name): OREGON VASCULAR AND VEIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 G ST STE 100
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

1460 G ST STE 100
SPRINGFIELD OR
97477-4112
US

V. Phone/Fax

Practice location:
  • Phone: 541-988-6330
  • Fax: 541-988-6340
Mailing address:
  • Phone: 541-988-6330
  • Fax: 541-988-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE VIRAMONTES JR.
Title or Position: OWNER
Credential:
Phone: 541-988-6330