Provider Demographics
NPI:1275795619
Name:COACTION, INC.
Entity Type:Organization
Organization Name:COACTION, INC.
Other - Org Name:MID-VALLEY PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-371-1970
Mailing Address - Street 1:3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1174
Mailing Address - Country:US
Mailing Address - Phone:503-371-1970
Mailing Address - Fax:503-371-0192
Practice Address - Street 1:3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1174
Practice Address - Country:US
Practice Address - Phone:503-371-1970
Practice Address - Fax:503-371-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500617813Medicaid