Provider Demographics
NPI:1710231550
Name:WVP MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:WVP MEDICAL GROUP, LLC
Other - Org Name:MICHAEL W KELBER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-371-7701
Mailing Address - Street 1:2365 GREAR ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2747
Mailing Address - Country:US
Mailing Address - Phone:503-391-6615
Mailing Address - Fax:
Practice Address - Street 1:2365 GREAR ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2747
Practice Address - Country:US
Practice Address - Phone:503-391-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WVP MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty