Healthcare Provider Details

I. General information

NPI: 1427289925
Provider Name (Legal Business Name): COUNTY OF LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SW NYE ST
NEWPORT OR
97365
US

IV. Provider business mailing address

36 SW NYE ST
NEWPORT OR
97365-3821
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-6611
  • Fax: 541-265-4194
Mailing address:
  • Phone: 541-265-0468
  • Fax: 541-265-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LESA WAGNER
Title or Position: CREDENTIALING
Credential:
Phone: 541-265-0445