Basic Information
| Provider Information | |||||||||
| NPI: | 1104025071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALINA | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 SE STRATUS AVE | ||||||||
| Address2: | WILLAMETTE VALLEY HOSPITALISTS | ||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971286255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034356441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2700 SE STRATUS AVE | ||||||||
| Address2: | WILLAMETTE VALLEY HOSPITALISTS | ||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971286255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034356441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10027617 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO174435 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2165904-03 | 05 | TX | MEDICAID |