Provider Demographics
NPI:1902138969
Name:OREGON HEART CENTER PC
Entity Type:Organization
Organization Name:OREGON HEART CENTER PC
Other - Org Name:SALEM HEART CENTER PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-561-7171
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0886
Mailing Address - Country:US
Mailing Address - Phone:503-814-4440
Mailing Address - Fax:503-814-4444
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-814-4440
Practice Address - Fax:503-814-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500618815Medicaid
ORR152591OtherMEDICARE