Provider Demographics
NPI:1942369772
Name:COASTAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:COASTAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-8315
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0239
Mailing Address - Country:US
Mailing Address - Phone:503-325-8315
Mailing Address - Fax:503-325-8602
Practice Address - Street 1:2158 EXCHANGE STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-325-8315
Practice Address - Fax:503-325-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231893Medicaid
OR381852Medicare ID - Type Unspecified
ORR155447Medicare Oscar/Certification
OR231893Medicaid