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General NPI Number Information
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NPI Number | 1619933264
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Entity Type | Organization
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Legal Business Name | SALEM SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/23/2006
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 2525 12ST SE SUITE 110
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City | SALEM
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State | OR
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Zip | 97302
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Country | US
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Telephone | 503-364-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 12TH STREET SE SUITE 110
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City | SALEM
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State | OR
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Zip | 97302
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Country | US
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Telephone | 503-364-3704
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Fax | 503-364-0081
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | MS. MEGAN JACKSON
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Credential |
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Telephone | 503-364-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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