MEDICARE: SALEM VASCULAR CONSULTANTS, LLP

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	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01816100	OTHER	OR	BLUE CROSS

General Provider Information

NPI Number	:	1508074147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM VASCULAR CONSULTANTS, LLP

Provider Business Mailing Address
First Line	:	1535 LIBERTY ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4345
Country	:	US
Telephone Number	:	503-371-8346
Fax Number	:	503-371-8334

Provider Business Practice Location Address
First Line	:	1535 LIBERTY ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4345
Country	:	US
Telephone Number	:	503-371-8346
Fax Number	:	503-371-8334

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. RICK D PITTMAN
Credential	:	MD
Telephone Number	:	503-371-8346

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	04/20/2008

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Directions to “SALEM VASCULAR CONSULTANTS, LLP ” Practice Location

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