Provider Demographics
NPI:1760404396
Name:NORTH BEND MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NORTH BEND MEDICAL CENTER INC
Other - Org Name:NBMC-LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TERSIGNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-267-5151
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4501
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38DO627047291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR690001817OtherRR MED GROUP PTAN NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR0000WBGKXOtherMEDICARE GROUP PIN NUMBER
OR133897Medicaid
OR38DO627047OtherCLIA NUMBER
OR500400245Medicaid
OR=========OtherGROUP TAX ID FOR BILLING