Provider Demographics
NPI:1972262129
Name:COUNTY OF LINCOLN
Entity Type:Organization
Organization Name:COUNTY OF LINCOLN
Other - Org Name:MATERNAL CHILD HEALTH - FAMILY CONNECTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-265-0445
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-0445
Mailing Address - Fax:844-760-0526
Practice Address - Street 1:255 SW COAST HWY STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4988
Practice Address - Country:US
Practice Address - Phone:541-265-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF LINCOLN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-15
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500803847Medicaid