1760404396 NPI number — NORTH BEND MEDICAL CENTER INC

Table of content: (NPI 1760404396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760404396 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:
NBMC-LABORATORY
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:
1760404396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
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:
07/24/2006

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: 291U00000X , with the licence number:  38DO627047 , 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: 690001817 . This is a "RR MED GROUP PTAN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1407812365 . This is a "NBMC GROUP NPI NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R0000WBGKX . This is a "MEDICARE GROUP PIN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 133897 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38DO627047 . This is a "CLIA NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 500400245 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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