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NPI Code Detail

MEDICARE: SANTIAM MOBILE MEDICINE LLC

MEDICARE: SANTIAM MOBILE MEDICINE 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
1363L00000XNurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750899035
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTIAM MOBILE MEDICINE LLC
Provider Business Mailing Address
First Line : PO BOX 118
Second Line :
City : STAYTON
State : OR
Zip : 97383-0118
Country : US
Telephone Number : 503-507-5356
Fax Number : 866-225-1708
Provider Business Practice Location Address
First Line : 41805 STAYTON SCIO RD SE
Second Line :
City : STAYTON
State : OR
Zip : 97383-9739
Country : US
Telephone Number : 503-507-5356
Fax Number : 866-225-2708
Authorized Official
Title or Position : MEMBER
Name : CASEY LULAY
Credential : MSN, FNP
Telephone Number : 503-507-5356
Provider Enumeration Date : 01/20/2018
Last Update Date : 05/31/2025

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Directions to “SANTIAM MOBILE MEDICINE LLC ” Practice Location

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