NPIMap

Organization Active NPI

South Salem Immediate Care Inc.

Doing business as DBA Urgent Care Clinic South

  • Urgent Care Clinic/Center
  • Salem, OR
National Provider Identifier
1871648402
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SOUTH SALEM IMMEDIATE CARE INC.
Doing business as
DBA Urgent Care Clinic South
Practice address
3777 Commercial St SE
Salem, OR 97302
Phone
(503) 588-1234
Fax
(503) 371-8662
NPI assigned
Jan 24, 2007
Last updated
Nov 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Authorized official

Name
Ms. Rachel Maddy
Title
President/Owner
Phone
(503) 588-1234

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary
Legal Medicine 173000000X MD11684 OR
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

3777 Commercial St SE
Salem, OR 97302

Mailing address

3777 Commercial St SE
Salem, OR 97302
Phone (503) 588-1234

Other identifiers 1

IdentifierTypeStateIssuer
130226MedicaidOR

Other names 1

  • DBA Urgent Care Clinic South Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543276800000",
    "number": "1871648402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-588-1234",
            "fax_number": "503-371-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-588-1234",
            "fax_number": "503-371-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SALEM IMMEDIATE CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-11-27",
        "status": "A",
        "authorized_official_last_name": "MADDY",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "503-588-1234",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "OR",
            "license": "MD11684",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130226",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Urgent Care Clinic South",
            "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 27, 2018; 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.