Organization
SALEM EMERGENCY PHYSICIANS SERVICE, PC
Active
Organization
SALEM EMERGENCY PHYSICIANS SERVICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT KELLY (MD)
(503) 561-5634
Entity
Organization
Contact information
Practice address
890 OAK STREET, SE BUILDING 'A', SALEM, OR 97301-3905
(503) 561-5634
(503) 814-1071
Mailing address
PO BOX 742547, LOS ANGELES, CA 90074-2547
(503) 561-5634
(503) 814-1071
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015388000
BLUE CROSS & BLUE SHIELD
—
01
—
042080
WASHINGTON L&I
—
05
—
115808
—
OR
05
—
168143
—
OR
01
—
68701001
GROUP HEALTH
—
05
—
7028699
—
WA
01
—
8902424
WASHINGTON CRIME VICTIMS
—
01
—
CR0251
RAILROAD MEDICARE
—
Enumeration date
06/12/2006
Last updated
11/05/2019
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