Healthcare Provider Details

I. General information

NPI: 1952389918
Provider Name (Legal Business Name): UNITED STATES COAST GUARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 SE 12TH PL
WARRENTON OR
97146-9311
US

IV. Provider business mailing address

2185 SE 12TH PL
WARRENTON OR
97146-9311
US

V. Phone/Fax

Practice location:
  • Phone: 503-861-6240
  • Fax: 503-861-6358
Mailing address:
  • Phone: 503-861-6240
  • Fax: 503-861-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA M MAGORTY
Title or Position: HEATH SERVICES TECHNICIAN
Credential:
Phone: 503-861-6249