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General NPI Number Information
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NPI Number | 1124311550
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Entity Type | Organization
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Legal Business Name | URGENT CARE CLINIC SOUTH
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 3777 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-3832
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Country | US
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Telephone | 503-588-1234
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Fax | 503-371-8662
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Provider Business Mailing Address
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Address Line | 3777 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-3832
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Country | US
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Telephone | 503-588-1234
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Fax | 503-371-8662
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Authorized Official
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Title or Position | OWNER
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Name | KARLEEN RAE KITZMILLER
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Credential |
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Telephone | 503-588-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD10412
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License Number State | OR
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