Provider Demographics
NPI:1497056022
Name:SALVIA MEDICA
Entity Type:Organization
Organization Name:SALVIA MEDICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-609-0780
Mailing Address - Street 1:443 NE KNOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3179
Mailing Address - Country:US
Mailing Address - Phone:503-609-0780
Mailing Address - Fax:503-282-1990
Practice Address - Street 1:443 NE KNOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3179
Practice Address - Country:US
Practice Address - Phone:503-609-0780
Practice Address - Fax:503-282-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service