SOUTH COAST HEALTHCARE LLC NPI 1134740152

NPI Information

  • NPI: 1134740152
  • Provider Name: SOUTH COAST HEALTHCARE LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Doing Business As: SOUTH COAST HEALTHCARE
  • CLIA Number: 38D2194671
  • Address: 29641 ELLENSBURG AVE
    GOLD BEACH, OR
    ZIP 97444
  • Phone: (541) 698-8080

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NPI Details

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
1363LF0000XNurse PractitionerFamilyNo
2261QP2300XClinic/CenterPrimary CareYes

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
1500783924MEDICAIDOREGON

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: 3/30/2025

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