Provider Demographics
NPI:1295964732
Name:COAST HEARING SERVICES
Entity type:Organization
Organization Name:COAST HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:541-265-6273
Mailing Address - Street 1:1217 N COAST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2499
Mailing Address - Country:US
Mailing Address - Phone:541-265-6273
Mailing Address - Fax:
Practice Address - Street 1:1217 N COAST HWY STE D
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2499
Practice Address - Country:US
Practice Address - Phone:541-265-6273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-404279237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022742Medicaid