Organization
SOUTH COAST SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER CLARKE (CLINIC ADMINISTRATOR)
(541) 266-3600
Entity
Organization
Contact information
Practice address
2699 N 17TH ST, COOS BAY, OR 97420
(541) 266-3600
(541) 269-0708
Mailing address
2699 N 17TH ST, A, COOS BAY, OR 97420
(541) 266-3600
(541) 269-0708
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165067
—
OR
Enumeration date
05/19/2006
Last updated
11/18/2008
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