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General NPI Number Information
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NPI Number | 1306274428
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Entity Type | Organization
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Legal Business Name | FIVE RED CAR DAY LLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 370 LINCOLN ST SE
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City | SALEM
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State | OR
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Zip | 97302-4350
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Country | US
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Telephone | 971-599-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 2755 COMMERCIAL ST SE # 101-327
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City | SALEM
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State | OR
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Zip | 97302-4981
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Country | US
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Telephone | 971-599-1002
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. LARA M KNUDSEN
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Credential | MD, MPH
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Telephone | 971-599-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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