NPIMap

Organization Active NPI

Waterfall Clinic, Incorporated

Doing business as Waterfall Healthy Neighbor Team

  • Federally Qualified Health Center (FQHC)
  • North Bend, OR
National Provider Identifier
1003445032
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WATERFALL CLINIC, INCORPORATED
Doing business as
Waterfall Healthy Neighbor Team
Practice address
1890 Waite St Ste 1
North Bend, OR 97459-1229
Phone
(541) 756-6232
NPI assigned
Apr 2, 2020
Last updated
Apr 2, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WATERFALL CLINIC, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrea Trenner
Title
Ceo
Phone
(541) 756-6232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1890 Waite St Ste 1
North Bend, OR 97459-1229

Mailing address

1890 Waite St Ste 1
North Bend, OR 97459-1229
Phone (541) 756-6232

Other identifiers 1

IdentifierTypeStateIssuer
213342MedicaidOR

Other names 1

  • Waterfall Healthy Neighbor Team Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Waterfall Community Health Center8 organizations share this tax ID, including this one
Part of
Waterfall Community Health Center

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1003445032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 WAITE ST STE 1",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974591229",
            "telephone_number": "541-756-6232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 WAITE ST STE 1",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974591229",
            "telephone_number": "541-756-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFALL CLINIC, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERFALL CLINIC, INCORPORATED",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "TRENNER",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-756-6232"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213342",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterfall Healthy Neighbor Team",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.