| Waterfall Clinic, Incorporated | |
|
826 S 11th St Coos Bay OR 97420 | |
| (541) 756-6232 | |
| (541) 756-6234 |
| Full Name | Waterfall Clinic, Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 826 S 11th St, Coos Bay, Oregon |
| Authorized Official Name and Position | Ava Kathleen Mcferon (CEO ASST.) |
| Authorized Official Contact | 5414357033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waterfall Clinic, Incorporated 1890 Waite St Ste 1 North Bend OR 97459-1229 Ph: (541) 756-6232 | Waterfall Clinic, Incorporated 826 S 11th St Coos Bay OR 97420 Ph: (541) 756-6232 |
| NPI Number | 1508133299 |
|---|---|
| Provider Enumeration Date | 11/23/2011 |
| Last Update Date | 02/26/2018 |
| Medicare PECOS PAC ID | 5698740355 |
|---|---|
| Medicare Enrollment ID | O20140729002307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508133299 | NPI | - | NPPES |
| 500647633 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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