Healthcare Provider Details

I. General information

NPI: 1699130757
Provider Name (Legal Business Name): SAMARITAN NORTH LINCOLN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

IV. Provider business mailing address

3011 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-2222
  • Fax: 541-996-5601
Mailing address:
  • Phone: 541-994-2222
  • Fax: 541-996-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number14-1456
License Number StateOR

VIII. Authorized Official

Name: LESLEY J. OGDEN
Title or Position: CEO
Credential: MD
Phone: 541-996-7100