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1111 N Roosevelt Dr Ste 210 Seaside OR 97138-4604 | |
(503) 738-3002 | |
(503) 738-3005 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1111 N Roosevelt Dr Ste 210, Seaside, Oregon |
Authorized Official Name and Position | Kimberly Kae Thomas (REVENUE CYCLE DIRECTOR) |
Authorized Official Contact | 5033384027 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2111 Exchange St Astoria OR 97103-3329 Ph: (503) 325-4321 | 1111 N Roosevelt Dr Ste 210 Seaside OR 97138-4604 Ph: (503) 738-3002 |
NPI Number | 1225694706 |
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Provider Enumeration Date | 05/10/2019 |
Last Update Date | 11/21/2019 |
Medicare PECOS PAC ID | 5294643359 |
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Medicare Enrollment ID | O20191112002902 |
Identifier | Type | State | Issuer |
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1225694706 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |