MEDICARE: COACTION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275795619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACTION, INC.

Provider Business Mailing Address
First Line	:	3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1174
Country	:	US
Telephone Number	:	503-371-1970
Fax Number	:	503-371-0192

Provider Business Practice Location Address
First Line	:	3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1174
Country	:	US
Telephone Number	:	503-371-1970
Fax Number	:	503-371-0192

Authorized Official
Title or Position	:	OWNER
Name	:	SHELLY R CARLSON
Credential	:
Telephone Number	:	503-371-1970

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	09/23/2019

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Directions to “COACTION, INC. ” Practice Location

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