Provider Demographics
NPI:1558545632
Name:OREGON COAST PODIATRY, LLC
Entity Type:Organization
Organization Name:OREGON COAST PODIATRY, LLC
Other - Org Name:SHERRY L WILLIAMS DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-756-1190
Mailing Address - Street 1:3229 BROADWAY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2203
Mailing Address - Country:US
Mailing Address - Phone:541-756-1190
Mailing Address - Fax:541-756-1199
Practice Address - Street 1:3229 BROADWAY ST
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2203
Practice Address - Country:US
Practice Address - Phone:541-756-1190
Practice Address - Fax:541-756-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00365213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDE3960OtherRAILROAD MEDICARE
OR5616010001Medicare NSC
ORDE3960OtherRAILROAD MEDICARE
ORU94619Medicare UPIN