Provider Demographics
NPI:1396858353
Name:SALEM FAMILY PHYSICIANS, P.C.
Entity type:Organization
Organization Name:SALEM FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-362-6304
Mailing Address - Street 1:1155 MISSION ST SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6228
Mailing Address - Country:US
Mailing Address - Phone:503-362-6304
Mailing Address - Fax:503-362-5570
Practice Address - Street 1:1155 MISSION ST SE
Practice Address - Street 2:SUITE 205
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6228
Practice Address - Country:US
Practice Address - Phone:503-362-6304
Practice Address - Fax:503-362-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18507173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058979Medicaid
OR058979Medicaid
ORF68401Medicare UPIN