1407812365 NPI number — NORTH BEND MEDICAL CENTER INC

Table of content: (NPI 1407812365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407812365 NPI number — NORTH BEND MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BEND MEDICAL CENTER INC
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:
Provider Other Organization Name Type Code:
6
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:
1407812365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 WOODLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOS BAY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97420-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-267-5151
Provider Business Mailing Address Fax Number:
541-266-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 WOODLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOS BAY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97420-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-267-5151
Provider Business Practice Location Address Fax Number:
541-266-4501
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TERSIGNI
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
541-267-5151

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  0000760 , 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: 383876 . This is a "MEDICARE OSCAR LISTED - 383876-BANDON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1386650778 . This is a "NBMC DAY SURGERY NPI #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 383853 . This is a "MEDICARE OSCAR LISTED-383853-GOLD BEACH" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1760404396 . This is a "NBMC LAB NPI NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 161133 . This is a "MEDICAID-OMAP GROUP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R0000WFBTV . This is a "GROUP MEDICARE PIN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1063428308 . This is a "NBMC XRAY-EKG NPI NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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