WVP MEDICAL GROUP, LLC (NPI# 1124352877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124352877 |
| Entity Type | Organization |
| Organization Name | WVP MEDICAL GROUP, LLC |
| Practice Address |
2485 12th St Se Salem OR 97302-2151 |
| Mailing Address |
2995 Ryan Dr Se Ste. 200 Salem OR 97301-5157 |
| Practice Telephone | 5033638047 |
| Practice Fax Number | 5033636571 |
| Mailing Telephone | 5033717701 |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2018-04-19 |
| Authorized Official Name | MR. DEAN G. ANDRETTA (CFO) |
| Authorized Official Telephone | 5033717701 |
| Is Organization Subpart | Y |
| Parent Organization Name | MID VALLEY IPA INC. (WVP HEALTH AUTHORITY) |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QB0002X |
Family Medicine Specialization: Obesity Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | PTAN | R151720 | 01 |
| OR | 288533 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2525 12th St Se, Ste 260, Salem, OR 973022153 | 5033636520 | 5039671472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922583616 | Wvp Medical Group, LLC | Clinic/Center | 2995 Ryan Dr Se Ste 200, Salem, OR 97301-5157 | 2018-09-27 |
| 1831504968 | Wvp Medical Group, LLC | Clinic/Center | 2485 12th St. Se, Salem, OR 97302-0000 | 2014-06-27 |
| 1982148789 | Wvp Medical Group, LLC | Internal Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2016-12-13 |
| 1538535059 | Wvp Medical Group, LLC | Clinic/Center | 1430 Monmouth St, Independence, OR 97351-1127 | 2015-08-19 |
| 1710231550 | Wvp Medical Group, LLC | Family Medicine | 2365 Grear St Ne, Salem, OR 97301-2747 | 2012-11-01 |
| 1518225242 | Wvp Medical Group, LLC | Clinic/Center | 1155 Mission St Se, Suite 205, Salem, OR 97302-6228 | 2012-05-01 |
| 1164780060 | Wvp Medical Group, LLC | Clinic/Center | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2012-04-27 |
| 1538459938 | Wvp Medical Group, LLC | Clinic/Center | 2478 13th St Se, Ste. 200, Salem, OR 97302-2546 | 2011-04-19 |
| 1750684767 | Wvp Medical Group, LLC | Clinic/Center | 5100 River Rd N, Keizer, OR 97303-5371 | 2010-12-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WVP MEDICAL GROUP, LLC | 245 Commercial St Se Ste 200, Salem, OR 97301 |
| Street Address |
2485 12TH ST SE |
| City | SALEM |
| State | OR |
| Zip Code | 97302-2151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962409888 | Harmon Thomas Harvey Jr. | Internal Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2005-07-07 |
| 1770133506 | Stacie Naseem Chance | Registered Nurse | 2485 12th St Se, Salem, OR 97302-2151 | 2019-09-13 |
| 1326458530 | Margaret Ellen Ayers-johnson | Physician Assistant | 2485 12th St Se, Salem, OR 97302-2151 | 2014-04-28 |
| 1295151686 | Casey Lulay | Nurse Practitioner | 2485 12th St Se, Salem, OR 97302-2151 | 2014-03-10 |
| 1821339862 | Christine J Rue | Physician Assistant | 2485 12th St Se, Salem, OR 97302-2151 | 2013-03-14 |
| 1861794893 | Steven Lionell Lewis Jr. | Physician Assistant | 2485 12th St Se, Salem, OR 97302-2151 | 2010-11-23 |
| 1700046596 | Jerrod Carl Mitzel | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2008-06-15 |
| 1043408024 | Christine Wung | Psychologist | 2485 12th St Se, Wvp Boulder Creek, Salem, OR 97302 | 2007-10-04 |
| 1306909288 | Douglas D. Eliason | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2006-12-19 |
| 1619914371 | Jeffrey L Turcot | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2006-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1306274428 | Five Red Car Day LLC | Clinic/Center | 4744 Liberty Rd S, Suite 120, Salem, OR 97302-5181 | 2013-10-29 |
| 1114177557 | Salem Memorial Hospital | Clinic/Center | 35629 Hwy. 72, Bld. 3, Salem, MO 65560-0719 | 2008-09-23 |
| 1831719244 | Abigail Bisson Nd Corp | Clinic/Center | 1205 Wallace Rd Nw, Salem, OR 97304-3007 | 2020-04-26 |
| 1326691486 | Livingston Hospital and Healthcare Services, Inc. | Clinic/Center | 117 E Main St, Salem, KY 42078-9998 | 2019-07-18 |
| 1033654793 | Phoenix Rising Family Medicine LLC | Clinic/Center | 810 Commercial St Se, Salem, OR 97302 | 2017-01-04 |
| 1689128308 | Salem Health | Clinic/Center | 2925 River Rd S, Salem, OR 97302-3677 | 2016-08-10 |
| 1356739593 | Quad Med LLC | Clinic/Center | 201 Jeans Dr, Salem, IN 47167-9200 | 2014-12-22 |
| 1871919639 | H. Thomas Harvey | Clinic/Center | 2995 Ryan Dr Se, Suite 200, Salem, OR 97301-5157 | 2014-03-17 |
| 1649522897 | Brmc Clinic At Salem, Arkansas | Clinic/Center | 106 Highway 62 W, Salem, AR 72576-8059 | 2012-10-12 |
| Find all providers in SALEM | ||||
Please comment or provide details below to improve the information on WVP MEDICAL GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.