1316027626 NPI number — MRS. DANA ELLEN COX RD

Table of content: MRS. DANA ELLEN COX RD (NPI 1316027626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316027626 NPI number — MRS. DANA ELLEN COX RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX
Provider First Name:
DANA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316027626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38901 S RUBY LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCIO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97374-9708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-394-3990
Provider Business Mailing Address Fax Number:
541-812-4004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
913 NW GARDEN VALLEY BLVD
Provider Second Line Business Practice Location Address:
NUTRITION & FOOD SERVICES
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  0 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112054 . This is a "PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 873928 . This is a "REGISTRATION NUMBER - RD" identifier . This identifiers is of the category "OTHER".




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