Providence Seaside Hospital, Providence Cannon Beach Clinic is a medicare enrolled primary clinic (Clinic/center - Rural Health) in Cannon Beach, Oregon. The current practice location for Providence Seaside Hospital, Providence Cannon Beach Clinic is 171 N Larch St Ste 16, Cannon Beach, Oregon. For appointments, you can reach them via phone at
(503) 717-7400. The mailing address for Providence Seaside Hospital, Providence Cannon Beach Clinic is Po Box 3397, Portland, Oregon and phone number is (503) 893-7120.
Providence Seaside Hospital, Providence Cannon Beach Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1841756764. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(503) 717-7400.
Primary Care Clinic Profile
| Full Name | Providence Seaside Hospital, Providence Cannon Beach Clinic |
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| Speciality | Clinic/Center |
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| Location | 171 N Larch St Ste 16, Cannon Beach, Oregon |
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| Authorized Official Name and Position | Donald Wayne Anderson (ASST CORP SECRETARY FOR ENROLLMENTS) |
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| Authorized Official Contact | 4255255392 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Providence Seaside Hospital, Providence Cannon Beach Clinic
Po Box 3397
Portland
OR 97208-3397
Ph: (503) 893-7120 | Providence Seaside Hospital, Providence Cannon Beach Clinic
171 N Larch St Ste 16
Cannon Beach
OR 97110-3103
Ph: (503) 717-7400 |
NPI Details:
| NPI Number | 1841756764 |
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| Provider Enumeration Date | 02/15/2019 |
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| Last Update Date | 02/06/2020 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 1557260106 |
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| Medicare Enrollment ID | O20190607002251 |
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Medical Identifiers
Medical identifiers for Providence Seaside Hospital, Providence Cannon Beach Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1841756764 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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