COUNTRYSIDE MEDICAL LLC NPI 1467205336

NPI Information

NPI: 1467205336
Provider Name: COUNTRYSIDE MEDICAL LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
2355 STATE ST STE 101
SALEM, OR
ZIP 97301
Phone: (503) 930-1854
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COUNTRYSIDE MEDICAL LLC is a primary care clinic center in Salem, OR. COUNTRYSIDE MEDICAL LLC NPI is 1467205336. The provider is registered as an organization entity type.

The provider's business location address is:

2355 STATE ST STE 101
SALEM, OR
ZIP 97301-541
Phone: (503) 930-1854

The provider's authorized official is Natalie Polzen .
The authorized official title is Fnp-c and has the following contact phone number (503) 930-1854.

The enumeration date for this NPI number is 4/9/2024 and was last updated on 4/9/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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