Provider Demographics
NPI:1114299153
Name:MILL CREEK FAMILY CLINIC INC
Entity Type:Organization
Organization Name:MILL CREEK FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:NELENE
Authorized Official - Last Name:KELBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-391-6615
Mailing Address - Street 1:4285 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4371
Mailing Address - Country:US
Mailing Address - Phone:503-931-2948
Mailing Address - Fax:
Practice Address - Street 1:4285 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4371
Practice Address - Country:US
Practice Address - Phone:503-391-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNP135211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty