Provider Demographics
NPI:1932325511
Name:MARYLHURST EAR, NOSE, THROAT, HEAD & NECK SURGERY
Entity Type:Organization
Organization Name:MARYLHURST EAR, NOSE, THROAT, HEAD & NECK SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:STEELE
Authorized Official - Last Name:COALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-636-6887
Mailing Address - Street 1:18380 WILLAMETTE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1200
Mailing Address - Country:US
Mailing Address - Phone:503-636-6887
Mailing Address - Fax:503-699-0303
Practice Address - Street 1:18380 WILLAMETTE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1200
Practice Address - Country:US
Practice Address - Phone:503-636-6887
Practice Address - Fax:503-699-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137856Medicaid