NPIMap

Organization Active NPI

Safeway Inc

  • Durable Medical Equipment & Medical Supplies
  • Salem, OR
National Provider Identifier
1104855154
Registry record updated Nov 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
001748 Issued in OR
Legal business name
SAFEWAY INC
Practice address
3285 Commercial St SE
Salem, OR 97302-4535
Phone
(503) 361-3346
Fax
(503) 361-3348
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle A Rivers, CPHT
Title
Managed Care Plan Specialist
Phone
(623) 869-3524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 001748 OR Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

3285 Commercial St SE
Salem, OR 97302-4535

Mailing address

20427 N 27TH Ave # Msc4551
Phoenix, AZ 85027-3241

Other identifiers 2

IdentifierTypeStateIssuer
3813777OtherOTHER ID NUMBER-COMMERCIAL NUMBER
170389MedicaidOR

Other names 1

  • SAFEWAY PHARMACY #0353 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001277 TX Part B Supplier - Centralized Flu Biller 8628980299 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3285 Commercial St SE
Salem, OR 97302
Phone (503) 361-3346

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226275200000",
    "number": "1104855154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20427 N 27TH AVE # MSC4551",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3285 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024535",
            "telephone_number": "503-361-3346",
            "fax_number": "503-361-3348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2008-11-10",
        "status": "A",
        "authorized_official_last_name": "RIVERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGED CARE PLAN SPECIALIST",
        "authorized_official_telephone_number": "623-869-3524",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OR",
            "license": "001748",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3813777",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170389",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #0353",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.