NPIMap

Organization Active NPI

Kenneth M. Wilson, M.D., P.C.

Doing business as Hand Surgery of Oregon

  • Specialist
  • Salem, OR
National Provider Identifier
1245662410
Registry record updated Jul 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD16217 Issued in OR
Legal business name
KENNETH M. WILSON, M.D., P.C.
Doing business as
Hand Surgery of Oregon
Practice address
700 Bellevue St SE Ste 260
Salem, OR 97301-3888
Phone
(503) 375-3636
Fax
(503) 375-3737
NPI assigned
Jul 30, 2013
Last updated
Jul 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2013

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

Authorized official

Name
Dr. Kenneth Mitchell Wilson, M.D.NPI 1558388025
Title
President
Phone
(936) 777-2255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD16217 OR Primary

Addresses

Primary practice location

700 Bellevue St SE Ste 260
Salem, OR 97301-3888

Mailing address

PO Box 1168
Canby, OR 97013-1168
Phone (936) 777-2255

Other identifiers 1

IdentifierTypeStateIssuer
045336MedicaidOR

Other names 1

  • Hand Surgery of Oregon Doing business as

National Provider Directory

National Provider Directory

Locations

1296 Commercial St SE
Ste 103
Salem, OR 97302
Phone (503) 375-2529

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1245662410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1168",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970131168",
            "telephone_number": "936-777-2255",
            "fax_number": "503-375-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 BELLEVUE ST SE STE 260",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013888",
            "telephone_number": "503-375-3636",
            "fax_number": "503-375-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH M. WILSON, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-30",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-777-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD16217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045336",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hand Surgery of Oregon",
            "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 Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.