COW CREEK HEALTH & WELLNESS ANNEX NPI 1205162021

NPI Information

NPI: 1205162021
Provider Name: COW CREEK HEALTH & WELLNESS ANNEX

Former Legal Business Name: COW CREEK HEALTH & WELLNESS ANNEX

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
270 GAZLEY BRIDGE RD
CANYONVILLE, OR
ZIP 97417
Phone: (541) 839-1345
Get Directions

COW CREEK HEALTH & WELLNESS ANNEX is a federally qualified health center (fqhc) clinic center in Canyonville, OR. COW CREEK HEALTH & WELLNESS ANNEX NPI is 1205162021. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Cow Creek Health & Wellness Annex.

The provider's business location address is:

270 GAZLEY BRIDGE RD
CANYONVILLE, OR
ZIP 97417-718
Phone: (541) 839-1345
Fax: (855) 670-1791

The provider's authorized official is Sharon A Stanphill .
The authorized official title is Chief Health Officer and has the following contact phone number (541) 672-8533.

The enumeration date for this NPI number is 10/29/2009 and was last updated on 8/5/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center			OREGON	No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500745176	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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