SOUTH COAST HEALTHCARE LLC NPI 1134740152

NPI Information

NPI: 1134740152
Provider Name: SOUTH COAST HEALTHCARE LLC

Doing Business As: SOUTH COAST HEALTHCARE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 38D2194671

Address:
29641 ELLENSBURG AVE
GOLD BEACH, OR
ZIP 97444
Phone: (541) 698-8080
Get Directions

SOUTH COAST HEALTHCARE LLC is a primary care clinic center in Gold Beach, OR. SOUTH COAST HEALTHCARE LLC NPI is 1134740152. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As South Coast Healthcare.

The provider's business location address is:

29641 ELLENSBURG AVE
GOLD BEACH, OR
ZIP 97444-701
Phone: (541) 698-8080

The provider's authorized official is Sara E Dickerson .
The authorized official title is Family Nurse Practitioner and has the following contact phone number (541) 425-5657.

The CLIA number assigned to this NPI record is 38D2194671 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/30/2020 and was last updated on 10/27/2020.

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	363LF0000X	Nurse Practitioner	Family			No
2	261QP2300X	Clinic/Center	Primary Care			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	500783924	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: 5/5/2024

NPI Synchronization or Removal

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