MEDICARE: SALEM RHEUMATOLOGY & INFUSIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1063053015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM RHEUMATOLOGY & INFUSIONS LLC

Provider Business Mailing Address
First Line	:	960 LIBERTY ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4195
Country	:	US
Telephone Number	:	503-399-0652
Fax Number	:	503-373-3852

Provider Business Practice Location Address
First Line	:	960 LIBERTY ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4195
Country	:	US
Telephone Number	:	503-399-0652
Fax Number	:	503-373-3852

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWN MACALESTER
Credential	:	DO
Telephone Number	:	503-399-0652

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	10/01/2019

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