Provider Demographics
NPI:1891977997
Name:VICKI L SELLER,M.D.,P.C.
Entity Type:Organization
Organization Name:VICKI L SELLER,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-315-5710
Mailing Address - Street 1:633 JASON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2750
Mailing Address - Country:US
Mailing Address - Phone:503-315-5710
Mailing Address - Fax:503-315-5719
Practice Address - Street 1:633 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2750
Practice Address - Country:US
Practice Address - Phone:503-315-5710
Practice Address - Fax:503-315-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14532207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136614Medicaid
OR0000BLBDWMedicare PIN
ORE20626Medicare UPIN