Provider Demographics
NPI:1114301553
Name:NORTH COAST MEDICAL CLINIC
Entity Type:Organization
Organization Name:NORTH COAST MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-791-3499
Mailing Address - Street 1:818 COMMERCIAL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4540
Mailing Address - Country:US
Mailing Address - Phone:503-568-7497
Mailing Address - Fax:
Practice Address - Street 1:818 COMMERCIAL ST STE 103
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4540
Practice Address - Country:US
Practice Address - Phone:503-568-7497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19799261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care