Salem Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

071573 Issued in OR

Legal business name

SALEM ENDOSCOPY CENTER, LLC

Practice address

875 Oak St SE
Suite 3095
Salem, OR 97301-3975

Phone

(503) 561-8170

Fax

(503) 561-8167

NPI assigned

Jun 10, 2006

Last updated

May 13, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Zoe Ann Wendolowski, RN

Title

Nurse Administrator

Phone

(503) 561-8170

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Listed as

Salem Endoscopy Center LLCCCN 38C0001073

Medicare certification status

ActiveFrom the Provider of Services file

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 2

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.

• Samantha Medkiff, CRNA

  • Certified Registered Nurse Anesthetist
  • Salem, OR
  • NPI 1194457952
  NPD (past)
• Edward H Schultheiss, MD

  • Gastroenterology Physician
  • Salem, OR
  • NPI 1730167586
  NPD (past)

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1730121401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 3095",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-8170",
            "fax_number": "503-561-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 OAK ST SE",
            "address_2": "SUITE 3095",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013975",
            "telephone_number": "503-561-8170",
            "fax_number": "503-561-8167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "WENDOLOWSKI",
        "authorized_official_first_name": "ZOE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "NURSE ADMINISTRATOR",
        "authorized_official_telephone_number": "503-561-8170",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OR",
            "license": "071573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE",
            "identifier": "339145",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005765",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00280629",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "P356301",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS",
            "identifier": "102447500",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Salem Correctional Pharmacy
• Salem Counseling Place
• Salem Dental LLC
• Salem Emergency Physicians Service, PC
• Salem Endodontic Associates
• Salem Eye Clinic
• Salem Family Cosmetic Dentistry
• Salem Family Physicians, P.C.
• Salem for Refugees
• Salem Free Medical Clinic

• Ambulatory Surgical Clinic/Center in Salem, OR
• Providers in Salem, OR by specialty
• Ambulatory Surgical Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; 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.