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General NPI Number Information
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NPI Number | 1578149639
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Entity Type | Organization
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Legal Business Name | AMG OF OREGON PC
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 675 ORCHARD HEIGHTS RD NW STE 200
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City | SALEM
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State | OR
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Zip | 97304-3042
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Country | US
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Telephone | 888-502-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 4045 E BELL RD STE 157
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City | PHOENIX
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State | AZ
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Zip | 85032-2240
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Country | US
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Telephone | 602-404-0015
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL J NOONAN
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Credential | MD
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Telephone | 888-502-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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