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NPI Code Detail

MEDICARE: PDH FAMILY MEDICAL HOME, LLC

MEDICARE: PDH FAMILY MEDICAL HOME, 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
1207Q00000XFamily Medicine PhysicianMD26240OR

General Provider Information

NPI Number : 1518285915
Entity Type Code : Organization
Provider Name (Legal Business Name) : PDH FAMILY MEDICAL HOME, LLC
Provider Business Mailing Address
First Line : 581 LANCASTER DR SE # 288
Second Line :
City : SALEM
State : OR
Zip : 97317-5642
Country : US
Telephone Number : 503-399-7474
Fax Number : 503-399-0679
Provider Business Practice Location Address
First Line : 608 LANCASTER DR SE
Second Line :
City : SALEM
State : OR
Zip : 97317-5643
Country : US
Telephone Number : 503-399-7474
Fax Number : 503-399-0679
Authorized Official
Title or Position : OWNER
Name : DR. PHYLLIS D HURSEY
Credential : MD FAAFP
Telephone Number : 503-399-7474
Provider Enumeration Date : 05/10/2010
Last Update Date : 05/10/2010

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Directions to “PDH FAMILY MEDICAL HOME, LLC ” Practice Location

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