COASTLINE CORVALLIS CLINIC LLC (NPI# 1457735615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457735615 |
| Entity Type | Organization |
| Organization Name | COASTLINE CORVALLIS CLINIC LLC |
| Other Organization Name | COASTLINE FOOT AND ANKLE CENTER |
| Practice Address |
1829 Nw Kings Blvd Corvallis OR 97330-1907 |
| Practice Telephone | 5417577100 |
| Mailing Telephone | 5417577100 |
| Mailing Fax Number | 5417577101 |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2020-03-10 |
| Authorized Official Name | LINZIE GOMEZ (MANAGER) |
| Authorized Official Telephone | 5033708784 |
| Is Organization Subpart | Y |
| Parent Organization Name | COASTLINE FOOT AND ANKLE CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
DP154513 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | R164712 | 05 |
| Other Name | Type Code |
|---|---|
| COASTLINE CORVALLIS CLINIC | Doing Business As Name - Organization |
| COASTLINE CORVALLIS CLINIC | Other Name - Individual/Organization |
| Coastline Foot and Ankle Center | Former Legal Business Name - Organization |
| Salem Foot and ankle clinic | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 350 Miller St Se, Salem, OR 973024272 | 5033708784 | 5033624017 |
| Street Address |
1829 NW KINGS BLVD |
| City | CORVALLIS |
| State | OR |
| Zip Code | 97330-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366688970 | Gregory T Soriano | Dentist | 1829 Nw Kings Blvd, Corvallis, OR 97330-1907 | 2009-01-02 |
| 1730459892 | Corvallis Family Dentistry, LLC | Dentist | 1829 Nw Kings Blvd, Corvallis, OR 97330-1907 | 2012-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235754912 | Miya Claborn | Counselor | 4495 Se Hwy 20, Corvallis, OR 97330 | 2020-06-09 |
| 1548889017 | Greydi Olvera | Counselor | Childrens Farm Home 4455 Ne Hwy 20, Corvallius, OR 97330 | 2020-04-14 |
| 1053953992 | Andie Marie Gaipo | Counselor | 4455 Ne Hwy 20 - Children's Farm Home, Corvallis, OR 97330 | 2019-10-11 |
| 1740847177 | Stephen Jack Eccles | Behavior Technician | Trillium Children's Farm Home, 4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-05-21 |
| 1750944815 | Tiffany Rene Flinchpaugh | Counselor | Children's Farm Home 4455 Hwy 20, Corvallis, OR 97330 | 2019-04-15 |
| 1679035455 | Isaiah Mile Cassidy | Counselor | Children's Farm Home-4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-04-02 |
| 1982168399 | Haylee Cramblit | Counselor | Children's Farm Home 4455 Ne Hwy 20, Corvallis, OR 97330 | 2019-01-30 |
| 1457835365 | Ashley Alyn Couch | Counselor | 4455 Hwy 20 Corvallis 97330, Corvallis, OR 97330 | 2018-09-18 |
| 1104318898 | Megan Gerding | Technician, Other | 996 Nw Circle Blvd Suite 103, Corvallis, OR 97330 | 2018-05-30 |
| 1700377108 | Pacific Hearing Services | Audiologist | 975 Nw Spruce Ave, Suite #101, Corvallis, OR 97330 | 2018-05-22 |
| Find all providers in zip 97330 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689800666 | Bsm Surgery Center LLC | Clinic/Center | 1128 Ne Second Street, Suite 104, Corvallis, OR 97330-6293 | 2009-06-04 |
| 1881850386 | Corvallis Clinic PC | Clinic/Center | 601 Nw Elks Drive, Corvallis, OR 97330-3781 | 2008-08-04 |
| 1649327008 | Samaritan Endoscopy LLC | Clinic/Center | 3509 Nw Samaritan Drive, Suite 201, Corvallis, OR 97330-3766 | 2007-01-05 |
| 1164829412 | Nw Surgical Center | Clinic/Center | 545 Sw 2nd St, Corvallis, OR 97333-4466 | 2014-12-02 |
| 1801210802 | Nw Surgical Center LLC | Clinic/Center | 545 Sw 2nd St, Corvallis, OR 97333-4466 | 2014-02-11 |
| 1730345596 | Corvallis Clinic PC | Clinic/Center | 444 Nw Elks Dr, Corvallis, OR 97330-3745 | 2008-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457826125 | Central Oregon Surgical Institute, LLC | Clinic/Center | 1550 Ne 27th St Ste 110, Bend, OR 97701-7728 | 2018-10-09 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1962920751 | West End Surgical, LLC | Clinic/Center | 9405 Sw Nimbus Ave, Beaverton, OR 97008 | 2017-09-01 |
| 1588181275 | Chase Gardens Surgery Center LLC | Clinic/Center | 360 S Garden Way Ste 100, Eugene, OR 97401-8173 | 2017-08-24 |
| 1164946984 | Northwest Renal Clinic, Inc. | Clinic/Center | 9701 Sw Barnes Rd Ste 110, Portland, OR 97225-6774 | 2017-08-02 |
| 1679939318 | Crater Lake Surgery Center LLC | Clinic/Center | 833 Bennett Ave, Medford, OR 97504-6715 | 2016-01-11 |
| 1902287469 | Gateway Dental Surgery Center | Clinic/Center | 10535 Ne Glisan St Ste 101, Portland, OR 97220-4095 | 2015-06-10 |
| 1760861835 | Central Oregon Surgery Center LLC | Clinic/Center | 1835 Nw Pence Ln Ste 100, Bend, OR 97703-1551 | 2015-05-22 |
| 1972902286 | Oregon Specialists Surgery Center LLC | Clinic/Center | 2785 River Rd S, Salem, OR 97302-5883 | 2014-08-22 |
| 1649612698 | Willamette Procedure Center PC | Clinic/Center | 2020 8th Ave Ste 212, West Linn, OR 97068-4657 | 2013-07-18 |
| Find all providers with the same taxonomy | ||||
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| 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.