# COASTLINE CORVALLIS CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COASTLINE FOOT AND ANKLE CLINIC
- **Other names:** Coastline Foot and Ankle Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457735615
- **Legal business name:** COASTLINE FOOT AND ANKLE CLINIC
- **Authorized official:** LINZIE GOMEZ (MANAGER)
- **Authorized official phone:** (503) 370-8784

## Contact information

- **Practice address:** 1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
- **Practice address phone:** (541) 757-7100
- **Mailing address:** 1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
- **Mailing address phone:** (541) 757-7100
- **Mailing address fax:** (541) 757-7101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | DP154513 | OR | Yes |

## Other

- **Enumeration date:** 07/16/2015
- **Last updated:** 03/10/2020