MEDICARE: PALLIATIVE CARE SERVICES, INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	363A00000X	Physician Assistant	PA01254	OR
3	364SA2200X	Adult Health Clinical Nurse Specialist	200770015CNS	OR
4	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

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

NPI Number	:	1861491813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1620 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2150
Country	:	US
Telephone Number	:	541-269-2986
Fax Number	:	541-269-7987

Provider Business Practice Location Address
First Line	:	1610 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2150
Country	:	US
Telephone Number	:	541-269-2986
Fax Number	:	541-269-7987

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LINDA JOY FURMAN GRILE
Credential	:
Telephone Number	:	541-269-2986

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/17/2008

1620 THOMPSON RD
COOS BAY, OR
97420-2150

Practice Phone: 541-269-2986
Practice Fax: 541-269-0576

1610 THOMPSON RD
COOS BAY, OR
97420-2150