COASTLINE CORVALLIS CLINIC LLC NPI 1457735615

NPI Information

NPI: 1457735615
Provider Name: COASTLINE CORVALLIS CLINIC LLC

Former Legal Business Name: COASTLINE FOOT AND ANKLE CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
1829 NW KINGS BLVD
CORVALLIS, OR
ZIP 97330
Phone: (541) 757-7100
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COASTLINE CORVALLIS CLINIC LLC is an ambulatory surgical clinic center in Corvallis, OR. COASTLINE CORVALLIS CLINIC LLC NPI is 1457735615. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Coastline Foot And Ankle Center.

The provider's business location address is:

1829 NW KINGS BLVD
CORVALLIS, OR
ZIP 97330-907
Phone: (541) 757-7100

The provider's authorized official is Linzie Gomez .
The authorized official title is Manager and has the following contact phone number (503) 370-8784.

The enumeration date for this NPI number is 7/16/2015 and was last updated on 3/10/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	DP154513	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	R164712	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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