| Alante Primary Care O Llc | |
|
1220 20th St Se Ste 310 Salem OR 97302-2400 | |
| (480) 631-4978 | |
| (844) 443-4378 |
| Full Name | Alante Primary Care O Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1220 20th St Se Ste 310, Salem, Oregon |
| Authorized Official Name and Position | Jacob Schaefer (CFO) |
| Authorized Official Contact | 5032018356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alante Primary Care O Llc 1220 20th St Se Salem OR 97302-1798 Ph: (480) 631-4978 | Alante Primary Care O Llc 1220 20th St Se Ste 310 Salem OR 97302-2400 Ph: (480) 631-4978 |
| NPI Number | 1003623224 |
|---|---|
| Provider Enumeration Date | 12/11/2024 |
| Last Update Date | 01/29/2025 |
| Medicare PECOS PAC ID | 5092235994 |
|---|---|
| Medicare Enrollment ID | O20250221003207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003623224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Jacqueline M Devaney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790370096 PECOS PAC ID: 4486087103 Enrollment ID: I20210512002897 |
| Provider Name | Jessica Ann Cassady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811326242 PECOS PAC ID: 3274760137 Enrollment ID: I20250106001676 |
| Provider Name | Teri L Selstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073881397 PECOS PAC ID: 6507029220 Enrollment ID: I20250306001152 |
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Alante Health - Oregon Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1220 20th St Se Ste 310, Salem, OR 97302 Phone: 480-631-4978 |