PHOENIX RISING FAMILY MEDICINE LLC (NPI# 1033654793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033654793 |
| Entity Type | Organization |
| Organization Name | PHOENIX RISING FAMILY MEDICINE LLC |
| Practice Address |
810 Commercial St Se Salem OR 97302 |
| Mailing Address |
Po Box 2693 Salem OR 97308-2693 |
| Practice Telephone | 9712271073 |
| Mailing Telephone | 5415566743 |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2018-07-31 |
| Authorized Official Name | JOEL E DUPUIS (MBR) |
| Authorized Official Telephone | 5415566743 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
201505391NP-PP | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500690272 | 05 | |
| OR | MEDICARE PTAN | R185124 | 01 |
| Street Address |
810 COMMERCIAL ST SE |
| City | SALEM |
| State | OR |
| Zip Code | 97302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194108365 | Danielle Marlene Dupuis | Nurse Practitioner | 810 Commercial St Se, Salem, OR 97302 | 2015-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
| Find all providers in zip 97302 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1306274428 | Five Red Car Day LLC | Clinic/Center | 4744 Liberty Rd S, Suite 120, Salem, OR 97302-5181 | 2013-10-29 |
| 1114177557 | Salem Memorial Hospital | Clinic/Center | 35629 Hwy. 72, Bld. 3, Salem, MO 65560-0719 | 2008-09-23 |
| 1831719244 | Abigail Bisson Nd Corp | Clinic/Center | 1205 Wallace Rd Nw, Salem, OR 97304-3007 | 2020-04-26 |
| 1326691486 | Livingston Hospital and Healthcare Services, Inc. | Clinic/Center | 117 E Main St, Salem, KY 42078-9998 | 2019-07-18 |
| 1689128308 | Salem Health | Clinic/Center | 2925 River Rd S, Salem, OR 97302-3677 | 2016-08-10 |
| 1356739593 | Quad Med LLC | Clinic/Center | 201 Jeans Dr, Salem, IN 47167-9200 | 2014-12-22 |
| 1871919639 | H. Thomas Harvey | Clinic/Center | 2995 Ryan Dr Se, Suite 200, Salem, OR 97301-5157 | 2014-03-17 |
| 1649522897 | Brmc Clinic At Salem, Arkansas | Clinic/Center | 106 Highway 62 W, Salem, AR 72576-8059 | 2012-10-12 |
| 1518225242 | Wvp Medical Group, LLC | Clinic/Center | 1155 Mission St Se, Suite 205, Salem, OR 97302-6228 | 2012-05-01 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.