Healthcare Provider Details

I. General information

NPI: 1629098157
Provider Name (Legal Business Name): OREGON COAST SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 THOMPSON RD
COOS BAY OR
97420-2040
US

IV. Provider business mailing address

1957 THOMPSON RD
COOS BAY OR
97420-2040
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-4429
  • Fax: 541-267-5470
Mailing address:
  • Phone: 541-267-4429
  • Fax: 541-267-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD26085
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD21855
License Number StateOR

VIII. Authorized Official

Name: DARA PARVIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-267-4429