MEDICARE: SALEM CLINIC, PC

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	208D00000X	General Practice 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

General Provider Information

NPI Number	:	1962781526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM CLINIC, PC

Provider Business Mailing Address
First Line	:	PO BOX 8100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97303-0900
Country	:	US
Telephone Number	:	503-399-2470
Fax Number	:	503-375-7429

Provider Business Practice Location Address
First Line	:	1174 CORNUCOPIA ST NW STE 120
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-3193
Country	:	US
Telephone Number	:	503-399-2424
Fax Number	:	503-375-7429

Authorized Official
Title or Position	:	ADMINISTRATOR/CAO
Name	:	MS. BARBARA GUNDER
Credential	:	CAO
Telephone Number	:	503-399-2470

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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Directions to “SALEM CLINIC, PC ” Practice Location

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