Basic Information
| Provider Information | |||||||||
| NPI: | 1033458807 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SILVERTON HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SILVERTON INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278 | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970710278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038738740 | ||||||||
| FaxNumber: | 5038742470 | ||||||||
| Practice Location | |||||||||
| Address1: | 452 WELCH ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038738740 | ||||||||
| FaxNumber: | 5038742470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2013 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | CAGEN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5038731615 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.