Provider Demographics
NPI:1053454355
Name:MARGARET A PORTWOOD
Entity Type:Organization
Organization Name:MARGARET A PORTWOOD
Other - Org Name:COASTAL HEALTH PRACTITIONERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-994-5591
Mailing Address - Street 1:3015 NE WEST DEVILS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-5131
Mailing Address - Country:US
Mailing Address - Phone:541-994-5591
Mailing Address - Fax:541-994-3735
Practice Address - Street 1:3015 NE WEST DEVILS LAKE ROAD
Practice Address - Street 2:COASTAL HEALTH PRACTITIONERS
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5131
Practice Address - Country:US
Practice Address - Phone:541-994-5591
Practice Address - Fax:541-996-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR167607Medicaid
OR167607Medicaid