Wild Rivers Physiatry, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD26085 Issued in OR

Legal business name

WILD RIVERS PHYSIATRY, INC

Practice address

585 5TH St
Brookings, OR 97415-9702

Phone

(707) 464-7840

Fax

(707) 464-7845

NPI assigned

Apr 22, 2008

Last updated

Apr 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Coelho, M.D.

Title

President

Phone

(707) 464-7840

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1598930430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974440950",
            "telephone_number": "707-464-7840",
            "fax_number": "707-464-7845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159702",
            "telephone_number": "707-464-7840",
            "fax_number": "707-464-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD RIVERS PHYSIATRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "COELHO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-464-7840",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD26085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RADIOGRAPHY AND FLUOROSCOPY",
            "identifier": "RHD146992",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273955",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Watkins, PTA
• Nancy Webb
• Sheri Louise Webster
• Aaron Weiss, PHARMD
• Katrina Jeannine West, QMHP
• Karen Stella Williams, C.O.T.A.
• Ronald B Williams, RPH
• Krista Nichole Wilson
• Melissa Louise Wilson, FAMILY NURSE PRACTIT
• Jackie Wiseman

• Specialist in Brookings, OR
• Providers in Brookings, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.