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General NPI Number Information
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NPI Number | 1538174958
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Entity Type | Organization
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Legal Business Name | BAY CLINIC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1750 THOMPSON ROAD
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City | COOS BAY
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State | OR
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Zip | 97420-2100
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Country | US
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Telephone | 541-269-0333
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Fax | 541-267-6904
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Provider Business Mailing Address
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Address Line | 1750 THOMPSON ROAD
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City | COOS BAY
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State | OR
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Zip | 97420-2100
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Country | US
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Telephone | 541-269-0333
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Fax | 541-267-6904
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. LINET SAMSON
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Credential | CEO
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Telephone | 541-269-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 496339-85
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License Number State | OR
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