| Vida Integrative Medicine & Mental Health | |
|
374 Owens St Se Ste 100 Salem OR 97302-4183 | |
| (503) 399-1400 | |
| (503) 399-1406 |
| Full Name | Vida Integrative Medicine & Mental Health |
|---|---|
| Speciality | Family Medicine |
| Location | 374 Owens St Se Ste 100, Salem, Oregon |
| Authorized Official Name and Position | Teri L Litke-fetsch (ADMINISTRATOR) |
| Authorized Official Contact | 5033991400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vida Integrative Medicine & Mental Health Po Box 883 Salem OR 97308-0883 Ph: (503) 399-1400 | Vida Integrative Medicine & Mental Health 374 Owens St Se Ste 100 Salem OR 97302-4183 Ph: (503) 399-1400 |
| NPI Number | 1063567832 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 04/11/2022 |
| Medicare PECOS PAC ID | 5496770547 |
|---|---|
| Medicare Enrollment ID | O20051007000846 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063567832 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Evelin R Dacker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861479396 PECOS PAC ID: 1759306806 Enrollment ID: I20051007000884 |
| Provider Name | Adrienne J Maynard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063559094 PECOS PAC ID: 0446311443 Enrollment ID: I20081209000785 |
| Provider Name | Jill Cohen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578981379 PECOS PAC ID: 8325336134 Enrollment ID: I20161011002516 |
| Provider Name | Heather Cecchini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679887673 PECOS PAC ID: 4880879402 Enrollment ID: I20180410001743 |
| Provider Name | Amanda Lena Dubois |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982279790 PECOS PAC ID: 6002213253 Enrollment ID: I20210930001622 |
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