Provider Demographics
NPI:1609850940
Name:KATHLEEN S FINLEY
Entity Type:Organization
Organization Name:KATHLEEN S FINLEY
Other - Org Name:SHADY COVE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-830-0333
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SHADY COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97539-0428
Mailing Address - Country:US
Mailing Address - Phone:541-878-2022
Mailing Address - Fax:541-878-1498
Practice Address - Street 1:21990 HWY 62
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-9717
Practice Address - Country:US
Practice Address - Phone:541-878-2022
Practice Address - Fax:541-878-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123633Medicaid
ORR117776Medicare ID - Type Unspecified
OR123633Medicaid