WATERFALL CLINIC, INCORPORATED (NPI# 1447889480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447889480 |
| Entity Type | Organization |
| Organization Name | WATERFALL CLINIC, INCORPORATED |
| Practice Address |
93670 Viking Ln North Bend OR 97459-8623 |
| Mailing Address |
1890 Waite St Ste 1 North Bend OR 97459-1229 |
| Practice Telephone | 5417566232 |
| Practice Fax Number | 5417566234 |
| Mailing Telephone | 5417566232 |
| Mailing Fax Number | 5414357033 |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2020-04-02 |
| Authorized Official Name | ANDREA TRENNER (CEO) |
| Authorized Official Telephone | 5417566232 |
| Is Organization Subpart | Y |
| Parent Organization Name | WATERFALL CLINIC, INCORPORATED |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 213342 | 05 |
| Other Name | Type Code |
|---|---|
| North Bay Elementary SBHC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508133299 | Waterfall Clinic, Incorporated | Clinic/Center | 826 S 11th St, Coos Bay, OR 97420 | 2011-11-23 |
| 1003445032 | Waterfall Clinic, Incorporated | Clinic/Center | 1890 Waite St Ste 1, North Bend, OR 97459-1229 | 2020-04-02 |
| 1437654779 | Waterfall Clinic, Incorporated | Community/Behavioral Health | 1890 Waite St Ste 1, North Bend, OR 97459-1229 | 2018-03-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WATERFALL CLINIC, INCORPORATED | 1890 Waite St Ste 1, North Bend, OR 97459 |
| Street Address |
93670 VIKING LN |
| City | NORTH BEND |
| State | OR |
| Zip Code | 97459-8623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750655452 | Kari Kaye Crockett | Counselor | 93670 Viking Ln, North Bend, OR 97459-8623 | 2012-02-28 |
| 1174897763 | Caterina Hall | Counselor | 93670 Viking Ln, North Bend, OR 97459-8623 | 2012-02-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568002749 | Ya-chi Claire Chang | Nurse Practitioner | 1229 1890 Waite St #1, North Bend, OR 97459 | 2020-01-15 |
| 1629573977 | Heather M Coates | Counselor | 400 Virginia Ave Ste 100, North Bend, OR 97459 | 2018-03-28 |
| 1205257219 | Melissa Sperry | Health Educator | 510 Lockhart Street, North Bend, OR 97459 | 2013-12-17 |
| 1265862627 | Elizabeth Sylvester | Counselor | 1592 Monroe Street, North Bend, OR 97459 | 2013-11-22 |
| 1124370291 | Brian Noble Thompson | Pharmacist | 3411 Broadway St., North Bend, OR 97459 | 2012-10-12 |
| 1295081230 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3411 Broadway St, North Bend, OR 97459 | 2012-07-27 |
| 1366728370 | Melissa Jean Kovach | Occupational Therapy Assistant | 3959 Sheridan Ave., North Bend, OR 97459 | 2011-10-24 |
| 1295045052 | Mary Kay Weikel | Massage Therapist | 3229 Broadway St Suite G Serenity Therapy Center, North Bend, OR 97459 | 2010-10-14 |
| 1902080013 | Anthony Eugene Baldacci | Registered Nurse | 1836 Meade Street, North Bend, OR 97459 | 2007-12-26 |
| 1952595340 | Inland Point Senior Estates Jv LLC | Clinic/Center | 2265 Inland Drive, North Bend, OR 97459 | 2007-08-29 |
| Find all providers in zip 97459 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003445032 | Waterfall Clinic, Incorporated | Clinic/Center | 1890 Waite St Ste 1, North Bend, OR 97459-1229 | 2020-04-02 |
| 1619915113 | Waterfall Clinic Incorporated | Clinic/Center | 1890 Waite St, Suite 1, North Bend, OR 97459-1229 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540398 | La Clinica Del Valle Family Healthcare Center Inc. | Clinic/Center | 102 Christian Avenue, Talent, OR 97540 | 2020-08-28 |
| 1790398048 | La Clinica Del Valle Family Healthcare Center Inc. | Clinic/Center | 307 Wagner Creek Road, Talent, OR 97540 | 2020-08-26 |
| 1922656289 | Clackamas County | Clinic/Center | 39831 Highway 26, Sandy, OR 97055-6558 | 2019-08-29 |
| 1063067312 | Virginia Garcia Memorial Health Center | Clinic/Center | 11300 Sw Hazelbrook Rd, Tualatin, OR 97062-6980 | 2019-08-05 |
| 1417411505 | Klamath Health Partnership, Inc | Clinic/Center | 2210 N Eldorado Ave Ste A, Klamath Falls, OR 97601-6418 | 2019-01-23 |
| 1679053946 | Siskiyou Community Health Center Inc | Clinic/Center | 830 Ne 9th St, Grants Pass, OR 97526-1626 | 2018-08-16 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1598284242 | Winding Waters Medical Clinic | Clinic/Center | 401b N Main St, Joseph, OR 97846-5030 | 2017-09-13 |
| 1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
| 1477005619 | Outside In | Clinic/Center | 1226 Sw 12th Ave, Portland, OR 97205-2029 | 2016-11-03 |
| Find all providers with the same taxonomy | ||||
| City | NORTH BEND |
| Zip Code | 97459 |
Please comment or provide details below to improve the information on WATERFALL CLINIC, INCORPORATED.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.