NPIMap

Organization Active NPI

Columbiacare Services Inc

Doing business as Pony Creek Board and Care

  • Community Health Clinic/Center
  • North Bend, OR
National Provider Identifier
1124534185
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COLUMBIACARE SERVICES INC
Doing business as
Pony Creek Board and Care
Practice address
2345 Marion St
North Bend, OR 97459-2637
Phone
(541) 270-0219
NPI assigned
Dec 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Authorized official

Name
Michael Sewitsky
Title
Finance Director
Phone
(541) 858-8170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

2345 Marion St
North Bend, OR 97459-2637

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170

Other names 1

  • Pony Creek Board and Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Columbiacare Services Inc42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Locations

2345 Marion St
North Bend, OR 97459
Phone (541) 271-0219

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/columbiacare/r4/

NPI Registry JSON

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

{
    "created_epoch": "1514419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514419200000",
    "number": "1124534185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044004",
            "telephone_number": "541-858-8170",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 MARION ST",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974592637",
            "telephone_number": "541-270-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIACARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-28",
        "last_updated": "2017-12-28",
        "status": "A",
        "authorized_official_last_name": "SEWITSKY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "541-858-8170"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pony Creek Board and Care",
            "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 Dec 28, 2017; 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.