MEDICARE: OREGON COAST SPINE INSTITUTE, LLC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD26085	OR
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	MD21855	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ7856	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1629098157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OREGON COAST SPINE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	1957 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-267-4429
Fax Number	:	541-267-5470

Provider Business Practice Location Address
First Line	:	1957 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-267-4429
Fax Number	:	541-267-5470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DARA PARVIN
Credential	:	M.D.
Telephone Number	:	541-267-4429

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/31/2008

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Directions to “OREGON COAST SPINE INSTITUTE, LLC ” Practice Location

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