WVP MEDICAL GROUP, LLC (NPI# 1750684767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750684767 |
| Entity Type | Organization |
| Organization Name | WVP MEDICAL GROUP, LLC |
| Practice Address |
5100 River Rd N Keizer OR 97303-5371 |
| Mailing Address |
2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 |
| Practice Telephone | 5033932533 |
| Practice Fax Number | 5033935978 |
| Mailing Telephone | 5033717701 |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2018-04-17 |
| Authorized Official Name | MR. DEAN ANDRETTA (CFO) |
| Authorized Official Telephone | 5033717701 |
| Is Organization Subpart | Y |
| Parent Organization Name | MID VALLEY IPA (WVP HEALTH AUTHORITY) |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 288533 | 05 |
| 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 |
| 1124352877 | Wvp Medical Group, LLC | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2009-09-29 |
| 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 |
5100 RIVER RD N |
| City | KEIZER |
| State | OR |
| Zip Code | 97303-5371 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962449405 | Jay A Jamieson | Family Medicine | 5100 River Rd N, Keizer, OR 97303-5371 | 2006-06-01 |
| 1073058368 | Madison Buda | Physician Assistant | 5100 River Rd N, Keizer, OR 97303-5371 | 2016-12-22 |
| 1124257886 | Quentin Wandyke Johnson | Family Medicine | 5100 River Rd N, Keizer, OR 97303-5371 | 2009-07-02 |
| 1851595037 | Keizer Family Physicians PC | Family Medicine | 5100 River Rd N, Keizer, OR 97303-5371 | 2007-06-12 |
| 1114957461 | Julie A Gilbert | Family Medicine | 5100 River Rd N, Keizer, OR 97303-5371 | 2006-07-03 |
| 1376585448 | Gregory M Thomas | Family Medicine | 5100 River Rd N, Keizer, OR 97303-5371 | 2006-06-12 |
| 1114965647 | Heather M Rollins | Physician Assistant | 5100 River Rd N, Keizer, OR 97303-5371 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649750175 | Kristin Marie Barz | Behavioral Analyst | 4690 12th Ave Ne, Keizer, OR 97303 | 2018-08-15 |
| 1003359605 | Angela Rose Richard | Community Health Worker | 3410 Cherry Avenue Ne, Keizer, OR 97303 | 2016-11-30 |
| 1881146629 | Alma Denise Vera | Dental Hygienist | 5825 Shoreview Lane Ste C, Keizer, OR 97303 | 2016-10-27 |
| 1679919849 | Ramya Shyamala Kamath | Dentist | 4817 River Rd N, Keizer, OR 97303 | 2013-05-15 |
| 1356682041 | Teresa M Treinen | Physical Therapist | 190 Sandy Drive N, Keizer, OR 97303 | 2013-03-06 |
| 1598001844 | Eagle Eye Vision Care LLC | Optometrist | 4048 River Road North, Keizer, OR 97303 | 2012-12-13 |
| 1245590553 | Thora Jane Stacy | Dental Assistant | 2300 N.e. Lacncaster Dr., Salem, OR 97303 | 2012-05-21 |
| 1295028850 | Rodger Nordskog Magnuson | Pharmacist | 5452 River Road N., Keizer, OR 97303 | 2011-05-16 |
| 1326299843 | Douglas Scott Hamblin | Pediatrics | 5685 Inland Shores Way, Keizer, OR 97303 | 2008-10-02 |
| 1982870382 | Debra Kaye Lynch | Podiatrist | 4905 River Road N, Keizer, OR 97303 | 2008-05-06 |
| Find all providers in zip 97303 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1871153585 | Full Bloom Natural Medicine, LLC | Clinic/Center | 922 Nw Circle Blvd Ste 180, Corvallis, OR 97330-1483 | 2019-06-14 |
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| 1770147357 | Uptown Providers PC | Clinic/Center | 397 Warner Milne Rd, Oregon City, OR 97045-4045 | 2019-04-29 |
| 1720549058 | Barbara Gilbertson, Do, Inc. | Clinic/Center | 1803b Main St, Klamath Falls, OR 97601-2636 | 2019-03-28 |
| 1033674841 | Jeremy Mikolai Nd Inc | Clinic/Center | 2540 Ne M L King Blvd, Portland, OR 97212-3732 | 2019-02-06 |
| 1326531666 | Working Class Medicine LLC | Clinic/Center | 2133 N. Willis Blvd, Studio D, Portland, OR 97217 | 2018-06-12 |
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| 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.