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General NPI Number Information
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NPI Number | 1871648402
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Entity Type | Organization
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Legal Business Name | SOUTH SALEM IMMEDIATE CARE INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 3777 COMMERCIAL ST SE
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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 | 503-588-1234
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Fax | 503-371-8662
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Provider Business Mailing Address
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Address Line | 3777 COMMERCIAL ST SE
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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 | 503-588-1234
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Fax | 503-371-8662
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. RACHEL MADDY
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Credential |
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Telephone | 503-588-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD11684
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License Number State | OR
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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