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525 N Bay St Waldport OR 97394-9010 | |
(541) 265-4947 | |
(541) 574-7670 |
Full Name | |
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Speciality | Clinic/Center |
Location | 525 N Bay St, Waldport, Oregon |
Authorized Official Name and Position | Lesa Wagner (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5412650445 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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36 Sw Nye St Newport OR 97365-3821 Ph: (541) 265-0468 | 525 N Bay St Waldport OR 97394-9010 Ph: (541) 265-4947 |
NPI Number | 1942946934 |
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Provider Enumeration Date | 05/11/2022 |
Last Update Date | 04/07/2023 |
Certification Date | 04/07/2023 |
Medicare PECOS PAC ID | 3375439862 |
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Medicare Enrollment ID | O20230320002778 |
Identifier | Type | State | Issuer |
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1942946934 | NPI | - | NPPES |
213144 | Medicaid | OR |