Provider Demographics
NPI:1104011071
Name:VITAL LINKS WEST LLC
Entity Type:Organization
Organization Name:VITAL LINKS WEST LLC
Other - Org Name:OREGON OPTIMAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:STAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-297-6163
Mailing Address - Street 1:660 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4414
Mailing Address - Country:US
Mailing Address - Phone:541-297-6163
Mailing Address - Fax:
Practice Address - Street 1:1200 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2114
Practice Address - Country:US
Practice Address - Phone:541-344-4594
Practice Address - Fax:541-686-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22731208600000X
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty