WVP MEDICAL GROUP, LLC (NPI# 1164780060) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164780060 |
| Entity Type | Organization |
| Organization Name | WVP MEDICAL GROUP, LLC |
| Other Organization Name | WVP FLAMING MEDICAL CENTER |
| Practice Address |
1000 Se Uglow Ave Dallas OR 97338-2645 |
| Mailing Address |
2995 Ryan Dr Se Ste 200 Salem OR 97301-5157 |
| Practice Telephone | 5036238376 |
| Mailing Telephone | 5033717701 |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2018-04-17 |
| Authorized Official Name | KATHY DEATON (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 5036238376 |
| Is Organization Subpart | Y |
| Parent Organization Name | WVP MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
DO15134 | OR | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
PA153023 | OR | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
PA00266 | OR | Ambulatory Health Care Facilities |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
DO10396 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 288533 | 05 |
| Other Name | Type Code |
|---|---|
| WVP Flaming Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922583616 | Wvp Medical Group, LLC | Clinic/Center | 2995 Ryan Dr Se Ste 200, Salem, OR 97301-5157 | 2018-09-27 |
| 1831504968 | Wvp Medical Group, LLC | Clinic/Center | 2485 12th St. Se, Salem, OR 97302-0000 | 2014-06-27 |
| 1982148789 | Wvp Medical Group, LLC | Internal Medicine | 5050 Skyline Village Loop S, Salem, OR 97306-9490 | 2016-12-13 |
| 1538535059 | Wvp Medical Group, LLC | Clinic/Center | 1430 Monmouth St, Independence, OR 97351-1127 | 2015-08-19 |
| 1710231550 | Wvp Medical Group, LLC | Family Medicine | 2365 Grear St Ne, Salem, OR 97301-2747 | 2012-11-01 |
| 1518225242 | Wvp Medical Group, LLC | Clinic/Center | 1155 Mission St Se, Suite 205, Salem, OR 97302-6228 | 2012-05-01 |
| 1538459938 | Wvp Medical Group, LLC | Clinic/Center | 2478 13th St Se, Ste. 200, Salem, OR 97302-2546 | 2011-04-19 |
| 1750684767 | Wvp Medical Group, LLC | Clinic/Center | 5100 River Rd N, Keizer, OR 97303-5371 | 2010-12-13 |
| 1124352877 | Wvp Medical Group, LLC | Family Medicine | 2485 12th St Se, Salem, OR 97302-2151 | 2009-09-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WVP MEDICAL GROUP, LLC | 245 Commercial St Se Ste 200, Salem, OR 97301 |
| Street Address |
1000 SE UGLOW AVE |
| City | DALLAS |
| State | OR |
| Zip Code | 97338-2645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497727127 | Tom L Flaming | Family Medicine | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2006-02-06 |
| 1598250292 | Jacob Mitchell | Physician Assistant | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2018-06-25 |
| 1932626132 | Harry Bret Schumilas | Family Medicine | 1000 Se Uglow Ave, Dallas, OR 97338 | 2017-08-28 |
| 1457751760 | Jessica Kingsbury | Nurse Practitioner | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2014-08-25 |
| 1700035565 | Kari Wattenbarger | Physician Assistant | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2008-09-16 |
| 1427247220 | Flaming Medical Center P.C. | Family Medicine | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2007-10-17 |
| 1336102201 | Anna U Severin | Physician Assistant | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2006-04-10 |
| 1740253103 | Jeffrey S Humphrey | Family Medicine | 1000 Se Uglow Ave, Dallas, OR 97338-2645 | 2006-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164932042 | Stephanie Marie Renfro | Massage Therapist | 289 E Ellendale Ave #601, Dallas, OR 97338 | 2017-10-05 |
| 1588185953 | Herbert Starr Woodward IIi | Dentist | 201 Se Washington St, Dallas, OR 97338 | 2017-07-06 |
| 1851708077 | David Mooso | Pharmacist | 321 Nw Kings Valley Highway, Dallas, OR 97338 | 2014-07-21 |
| 1841615556 | Leslie Lytle | Counselor | 1020 Sw Maple St., Dallas, OR 97338 | 2014-03-04 |
| 1205265493 | Chung-fan Ni | Counselor | 182 S. W. Academy St., Academy Building, Dallas, OR 97338 | 2013-11-07 |
| 1215204300 | Ron Fritz | Counselor | 239 E. Ellendale, Suite 602, Dallas, OR 97338 | 2011-11-17 |
| 1235420167 | Deborah Kennedy | Counselor | 527 Ne Fern Ave, Dallas, OR 97338 | 2011-04-26 |
| 1821229774 | Chelsea Ruhoff Lee | Physician Assistant | 1000 Se Uglow Avenue, Flaming Medical Center, Dallas, OR 97338 | 2009-07-27 |
| 1013128560 | Larry J Vuylsteke | Social Worker | 182 S.w. Academy, Dallas, OR 97338 | 2007-05-25 |
| 1093926123 | Justin W Reed | Counselor | Academy Building, 182 S.w. Academy St. Suite 304, Dallas, OR 97338 | 2007-05-24 |
| Find all providers in zip 97338 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1548752850 | Susan Bacsik Do Pllc | Clinic/Center | 730 N Bishop Ave, Dallas, TX 75208-4338 | 2018-06-01 |
| 1255820239 | Fitzgerald Family Medicine | Clinic/Center | 289 E Ellendale Ave Ste 602, Dallas, OR 97338-1570 | 2018-05-06 |
| 1447759212 | Quadmed Medical Clinics of Texas, P.a. D/b/a Quadmed Medical Grou | Clinic/Center | 17655 Waterview Parkway, Dallas, TX 75252 | 2018-02-07 |
| 1700328325 | Daniel Health & Wellness, Pllc | Clinic/Center | 17762 Preston Rd Ste 114, Dallas, TX 75252-5730 | 2016-11-14 |
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| Find all providers in DALLAS | ||||
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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.