Organization
WVP MEDICAL GROUP, LLC
Active
Parent organization
WVP MEDICAL GROUP
Other names
WVP Flaming Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WVP MEDICAL GROUP
Authorized official
KATHY DEATON (PRACTICE ADMINISTRATOR)
(503) 623-8376
Entity
Organization
Contact information
Practice address
1000 SE UGLOW AVE, DALLAS, OR 97338-2645
(503) 623-8376
Mailing address
2995 RYAN DR SE STE 200, SALEM, OR 97301-5157
(503) 371-7701
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
DO10396
OR
261QP2300X
Primary Care Clinic/Center
DO15134
OR
261QP2300X
Primary Care Clinic/Center
PA00266
OR
261QP2300X
Primary Care Clinic/Center
PA153023
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288533
—
OR
Enumeration date
04/27/2012
Last updated
04/17/2018
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