Organization
PHOENIX RISING FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL E DUPUIS (MBR)
(541) 556-6743
Entity
Organization
Contact information
Practice address
810 COMMERCIAL ST SE, SALEM, OR 97302
(971) 227-1073
Mailing address
PO BOX 2693, SALEM, OR 97308-2693
(541) 556-6743
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
201505391NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500690272
—
OR
01
—
R185124
MEDICARE PTAN
OR
Enumeration date
01/04/2017
Last updated
07/31/2018
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