Individual ProviderJohn J CoyleSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1500 NW Bethany Blvd, 320, Beaverton, OR 97006-5208(503) 567-3260(208) 661-7761PECOS EnrollmentBased on the most recent information from CMS, provider John J Coyle does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1336316447Provider TypeIndividualFull NameCoyle, John JGenderMaleSole ProprietorYesEnumeration Date5/8/2008Last Updated11/12/2015Contact InformationPractice LocationPractice Address1500 NW Bethany Blvd, 320, Beaverton, OR 97006-5208Phone(503) 567-3260Fax(503) 567-3264Mailing LocationMailing Address6221 NE Halsey St, Portland, OR 97213-4717Phone(208) 661-7761FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLMSW-28565IdahoProvider IdentifiersIDDescriptionIssuerID164936DescriptionMedicaidIssuerUnlistedOregon