WATERFALL CLINIC INCORPORATED (NPI# 1619915113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619915113 |
| Entity Type | Organization |
| Organization Name | WATERFALL CLINIC INCORPORATED |
| Other Organization Name | WATERFALL COMMUNITY HEALTH CENTER |
| Practice Address |
1890 Waite St Suite 1 North Bend OR 97459-1229 |
| Practice Telephone | 5417566232 |
| Practice Fax Number | 5417566234 |
| Mailing Telephone | 5417566232 |
| Mailing Fax Number | 5417566234 |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-06-30 |
| Authorized Official Name | MRS. ANDREA TRENNER (EXECUTIVE DIRECTOR/CEO) |
| Authorized Official Telephone | 5417566232 |
| Is Organization Subpart | N |
| 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 | 227623 | 05 | |
| OR | 213342 | 05 |
| Other Name | Type Code |
|---|---|
| Waterfall Community Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609151810 | Waterfall Clinic Incorporated | Clinic/Center | 400 Fir Ave, Powers, OR 97466 | 2011-10-19 |
| 1851892509 | Waterfall Clinic Incorporated | Counselor | 1890 Waite St Ste 1, North Bend, OR 97459-1229 | 2018-02-27 |
| Street Address |
1890 WAITE ST SUITE 1 |
| City | NORTH BEND |
| State | OR |
| Zip Code | 97459-1229 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316921646 | Innovative Physical Therapy, Inc | Physical Therapist | 1890 Waite St, Suite 5, North Bend, OR 97459-1229 | 2005-11-30 |
| 1083246730 | Lori Shott | Registered Nurse | 1890 Waite St, North Bend, OR 97459-1229 | 2020-02-11 |
| 1689141236 | Toyin A Akanni | Nurse Practitioner | 1890 Waite St, North Bend, OR 97459-1229 | 2018-10-31 |
| 1043719990 | Shu-wen Cheng | Nurse Practitioner | 1890 Waite St, North Bend, OR 97459-1229 | 2018-02-06 |
| 1639555436 | Stephanie Hodges | Nurse Practitioner | 1890 Waite St, North Bend, OR 97459-1229 | 2015-08-04 |
| 1629366216 | Cathleen Marie Delibero | Counselor | 1890 Waite St, North Bend, OR 97459-1229 | 2011-07-15 |
| 1477718419 | Laura Jean Burnside-mcelligott | Registered Nurse | 1890 Waite St, Ste 1, North Bend, OR 97459-1229 | 2008-07-18 |
| 1891978763 | Judith Myrick Randall | Nurse Practitioner | 1890 Waite St, Ste 1, North Bend, OR 97459-1229 | 2007-12-13 |
| 1518164201 | Astrid Diepenbroek | Dental Hygienist | 1890 Waite St, Suite 1, North Bend, OR 97459-1229 | 2007-06-27 |
| 1114137494 | Gladys Shade | Social Worker | 1890 Waite St, Suite 1, North Bend, OR 97459-1229 | 2007-05-23 |
| Find all providers in the same location | ||||
| 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 |
| 1447889480 | Waterfall Clinic, Incorporated | Clinic/Center | 93670 Viking Ln, North Bend, OR 97459-8623 | 2020-04-02 |
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|---|---|---|---|---|
| 1215540398 | La Clinica Del Valle Family Healthcare Center Inc. | Clinic/Center | 102 Christian Avenue, Talent, OR 97540 | 2020-08-28 |
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| 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.