WILD RIVERS PHYSIATRY INC NPI 1598930430

NPI Information

NPI: 1598930430
Provider Name: WILD RIVERS PHYSIATRY, INC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
585 5TH ST
BROOKINGS, OR
ZIP 97415
Phone: (707) 464-7840
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WILD RIVERS PHYSIATRY, INC is a specialist in Brookings, OR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. WILD RIVERS PHYSIATRY, INC NPI is 1598930430. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

585 5TH ST
BROOKINGS, OR
ZIP 97415-702
Phone: (707) 464-7840
Fax: (707) 464-7845

The provider's authorized official is Paul Coelho .
The authorized official title is President and has the following contact phone number (707) 464-7840.

The enumeration date for this NPI number is 4/22/2008 and was last updated on 4/22/2008.

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	174400000X	Specialist		MD26085	OREGON	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	273955	MEDICAID	OREGON
2	H00384	MEDICARE UPIN	OREGON
3	133733	MEDICARE PIN	OREGON
4	RHD146992	OTHER	OREGON	RADIOGRAPHY AND FLUOROSCOPY

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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