Basic Information
| Provider Information | |||||||||
| NPI: | 1528219326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARION COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 CENTER ST NE | ||||||||
| Address2: | SUITE 2360 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885057 | ||||||||
| FaxNumber: | 5035662971 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 CENTER ST NE | ||||||||
| Address2: | SUITE 2360 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885057 | ||||||||
| FaxNumber: | 5035662971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2008 | ||||||||
| LastUpdateDate: | 10/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | WIC PROGRAM SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5035854947 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUBDIVISON OF THE STATE OF OREGON | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | 805533 | OR | Y | Agencies | Public Health or Welfare |
No ID Information.