NPI:
1841756764
Provider Name:
PROVIDENCE HEALTH & SERVICES OREGON
Doing Business As: PROVIDENCE SEASIDE HOSPITAL, PROVIDENCE CANNON BEACH CLINIC
Classification:
Clinic/Center - 261QR1300X
Entity Type:
Organization
Specialization: Rural Health
CLIA Number: 38D0939584
Address:
171 N LARCH ST STE 16
CANNON BEACH, OR
ZIP 97110
Phone:
(503) 717-7400
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PROVIDENCE HEALTH & SERVICES OREGON is a rural health clinic center in Cannon Beach, OR. PROVIDENCE HEALTH & SERVICES OREGON NPI is 1841756764. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Seaside Hospital, Providence Cannon Beach Clinic.
The provider's business location address is:
171 N LARCH ST STE 16
CANNON BEACH, OR
ZIP 97110-103
Phone: (503) 717-7400
The provider's authorized official is Donald Wayne Anderson .
The authorized official title is Asst Corp Secretary For Enrollments and has the following contact phone number (425) 525-5392.
The CLIA number assigned to this NPI record is 38D0939584 - rural health clinic with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 2/15/2019 and was last updated on 2/6/2020.