Provider Demographics
NPI:1770608424
Name:US COAST GUARD MEDICAL CLINIC NORTH BEND
Entity type:Organization
Organization Name:US COAST GUARD MEDICAL CLINIC NORTH BEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-756-9237
Mailing Address - Street 1:2000 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2300
Mailing Address - Country:US
Mailing Address - Phone:541-756-9234
Mailing Address - Fax:541-756-9617
Practice Address - Street 1:2000 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2300
Practice Address - Country:US
Practice Address - Phone:541-756-9234
Practice Address - Fax:541-756-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057309171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty