WVP MEDICAL GROUP LLC NPI 1124352877

NPI Information

NPI: 1124352877
Provider Name: WVP MEDICAL GROUP, LLC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
Address: 2485 12TH ST SE
SALEM, OR
ZIP 97302
Phone: (503) 363-8047

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NPI Details

WVP MEDICAL GROUP, LLC is a primary care clinic center in Salem, OR. WVP MEDICAL GROUP, LLC NPI is 1124352877. The provider is registered as an organization entity type.

The provider's business location address is:

2485 12TH ST SE
SALEM, OR
ZIP 97302-151
Phone: (503) 363-8047
Fax: (503) 363-6571

The provider's authorized official is Dean G. Andretta .
The authorized official title is Cfo and has the following contact phone number (503) 371-7701.

The enumeration date for this NPI number is 9/29/2009 and was last updated on 4/19/2018.

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
2	207QB0002X	Family Medicine	Obesity Medicine			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	R151720	OTHER	OREGON	PTAN
2	288533	MEDICAID	OREGON

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: 11/21/2025

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