Organization
SOUTH COAST HEALTHCARE LLC
Active
Other names
South Coast Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
SARA E DICKERSON NP (FAMILY NURSE PRACTITIONER)
(541) 425-5657
Entity
Organization
Contact information
Practice address
29641 ELLENSBURG AVE, GOLD BEACH, OR 97444-8701
(541) 698-8080
Mailing address
29641 ELLENSBURG AVE, GOLD BEACH, OR 97444-8701
(541) 425-5657
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500783924
—
OR
Enumeration date
04/30/2020
Last updated
10/27/2020
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