Organization
COASTLINE CORVALLIS CLINIC LLC
Active
Parent organization
COASTLINE FOOT AND ANKLE CLINIC
Other names
Coastline Foot and Ankle Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTLINE FOOT AND ANKLE CLINIC
Authorized official
LINZIE GOMEZ (MANAGER)
(503) 370-8784
Entity
Organization
Contact information
Practice address
1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
(541) 757-7100
Mailing address
1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
(541) 757-7100
(541) 757-7101
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
DP154513
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R164712
—
OR
Enumeration date
07/16/2015
Last updated
03/10/2020
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