Mill Creek Family Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

NP135211 Issued in OR

Legal business name

MILL CREEK FAMILY CLINIC INC

Practice address

4285 Commercial St SE
Suite 120
Salem, OR 97302-4371

Phone

(503) 391-6615

NPI assigned

Feb 7, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Peggy Nelene Kelber

Title

Office Manager

Phone

(503) 391-6615

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sheila L. Wettlaufer, CSFNP

  • Family Medicine Physician
  • Salem, OR
  • NPI 1679513493
  Medicare reassignment NPD

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1114299153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4285 COMMERCIAL ST SE",
            "address_2": "SUITE 120",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024371",
            "telephone_number": "503-931-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4285 COMMERCIAL ST SE",
            "address_2": "SUITE 120",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024371",
            "telephone_number": "503-391-6615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL CREEK FAMILY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "KELBER",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "NELENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-391-6615",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "NP135211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Midwife Lennon LLC
• Holly Leah Miguel, FNP
• Brett W Mikeska, M D
• Rebekah Miles, BA
• Mill Creek Dental LLC
• Mill Creek Medical Laboratory LLC
• Dakota Millak
• Cindy Marisol Millan, FNP
• Leticia Millard
• Heidi Miller McSmith, MSW, QMHP

• Family Medicine Physician in Salem, OR
• Providers in Salem, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.