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General NPI Number Information
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NPI Number | 1740946128
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Entity Type | Organization
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Legal Business Name | PACIFIC CARDIOVASCULAR CENTER, LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 550 HAWTHORNE AVE SE
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City | SALEM
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State | OR
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Zip | 97301-5206
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Country | US
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Telephone | 971-707-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 550 HAWTHORNE AVE SE
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City | SALEM
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State | OR
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Zip | 97301-5206
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Country | US
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Telephone | 971-707-4525
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RAGHUNANDAN KAMINENI
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Credential | MD
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Telephone | 971-707-4525
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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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