Provider Demographics
NPI:1013587484
Name:BANDON COMMUNITY HEALTH CTR
Entity Type:Organization
Organization Name:BANDON COMMUNITY HEALTH CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-347-2529
Mailing Address - Street 1:1010 1ST ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9301
Mailing Address - Country:US
Mailing Address - Phone:541-347-2529
Mailing Address - Fax:541-347-9196
Practice Address - Street 1:312 TICHENOR ST
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-8672
Practice Address - Country:US
Practice Address - Phone:541-347-2529
Practice Address - Fax:541-347-9196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANDON COMMUNITY HEALTH CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)