1053454355 NPI number — MARGARET A PORTWOOD

Table of content: (NPI 1053454355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053454355 NPI number — MARGARET A PORTWOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGARET A PORTWOOD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COASTAL HEALTH PRACTITIONERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053454355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3015 NE WEST DEVILS LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97367-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-994-5591
Provider Business Mailing Address Fax Number:
541-994-3735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 NE WEST DEVILS LAKE ROAD
Provider Second Line Business Practice Location Address:
COASTAL HEALTH PRACTITIONERS
Provider Business Practice Location Address City Name:
LINCOLN CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97367-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-994-5591
Provider Business Practice Location Address Fax Number:
541-996-7294
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PORTWOOD
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
A
Authorized Official Title or Position:
FNP
Authorized Official Telephone Number:
541-994-5591

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 167607 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com