NPIMap

Organization Active NPI

Waterfall Clinic Incorporated

  • Federally Qualified Health Center (FQHC)
  • Coos Bay, OR
National Provider Identifier
1669067369
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WATERFALL CLINIC INCORPORATED
Practice address
465 Elrod Ave
Coos Bay, OR 97420
Phone
(541) 756-6232
Fax
(541) 756-6234
NPI assigned
Mar 4, 2021
Last updated
Mar 4, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
WATERFALL CLINIC, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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 Primary

Addresses

Primary practice location

465 Elrod Ave
Coos Bay, OR 97420

Mailing address

1890 Waite Street
Suite 1
North Bend, OR 97459-3409
Phone (541) 756-6232

National Provider Directory

National Provider Directory
Tax ID family
Waterfall Clinic Inc8 organizations share this tax ID, including this one
Part of
Waterfall Clinic Inc

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1669067369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 WAITE STREET",
            "address_2": "SUITE 1",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593409",
            "telephone_number": "541-756-6232",
            "fax_number": "541-756-6234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 ELROD AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-756-6232",
            "fax_number": "541-756-6234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFALL CLINIC INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WATERFALL CLINIC, INCORPORATED",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-02-25",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; 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.