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General NPI Number Information
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NPI Number | 1386280220
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Entity Type | Organization
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Legal Business Name | COMPASSION CARE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 1025 2ND ST NW
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City | SALEM
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State | OR
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Zip | 97304-4001
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Country | US
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Telephone | 503-559-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 801 RUMSEY CT NW
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City | SALEM
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State | OR
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Zip | 97304-3792
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Country | US
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Telephone | 503-559-3312
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCI LYN COGDILL
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Credential | NP
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Telephone | 503-559-3312
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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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