Provider Demographics
NPI:1124426291
Name:CENTRAL OREGON INTERGOVERNMENTAL COUNCIL (COIC)
Entity type:Organization
Organization Name:CENTRAL OREGON INTERGOVERNMENTAL COUNCIL (COIC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OVER TRANSPORTATION
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-548-9543
Mailing Address - Street 1:334 NE HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4727
Mailing Address - Country:US
Mailing Address - Phone:541-548-8163
Mailing Address - Fax:541-923-3416
Practice Address - Street 1:1250 NE BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5013
Practice Address - Country:US
Practice Address - Phone:541-504-3310
Practice Address - Fax:541-389-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181996OtherSTATE OF OREGON OHA MEDICAID PROVIDER NUMBER