Provider Demographics
NPI:1225861420
Name:PURE HEALTH MEDICAL CLINIC
Entity type:Organization
Organization Name:PURE HEALTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCP
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:971-273-0084
Mailing Address - Street 1:631 JASON ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2357
Mailing Address - Country:US
Mailing Address - Phone:971-273-0084
Mailing Address - Fax:
Practice Address - Street 1:631 JASON ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2357
Practice Address - Country:US
Practice Address - Phone:971-273-0084
Practice Address - Fax:971-925-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty