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Organization

WATERFALL CLINIC, INCORPORATED

Active
Parent organization
WATERFALL CLINIC, INCORPORATED
Organization subpart
Yes

Provider details

NPI number
Legal business name
WATERFALL CLINIC, INCORPORATED
Authorized official
AVA KATHLEEN MCFERON (CEO ASST.)
(541) 435-7033
Entity
Organization

Contact information

Practice address
826 S 11TH ST, COOS BAY, OR 97420
(541) 756-6232
(541) 756-6234
Mailing address
1890 WAITE ST, STE 1, NORTH BEND, OR 97459-1229
(541) 756-6232
(541) 756-6234

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500647633
OR
Enumeration date
11/23/2011
Last updated
02/26/2018
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