Provider Demographics
NPI:1093253825
Name:SALUTEM PRIMUM LLC
Entity Type:Organization
Organization Name:SALUTEM PRIMUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERACHA KOVACHEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-502-5750
Mailing Address - Street 1:175 W B ST BLDG K2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4575
Mailing Address - Country:US
Mailing Address - Phone:718-502-5750
Mailing Address - Fax:
Practice Address - Street 1:1919 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1887
Practice Address - Country:US
Practice Address - Phone:718-502-5750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty