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NPI Code Detail

MEDICARE: CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS

MEDICARE: CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician
2125J00000XDental Therapist
3251S00000XCommunity/Behavioral Health Agency
4261QF0400XFederally Qualified Health Center (FQHC)
5261QC1500XCommunity Health Clinic/Center
6332800000XIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
7261QP2300XPrimary Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3RP-0003971OTHEROROREGON BOARD OF PHARMACY - RETAIL DRUG OUTLET
4RP-0003971-CSOTHEROROREGON BOARD OF PHARMACY - CONTROLLED SUBSTANCE

General Provider Information

NPI Number : 1780755454
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
Provider Business Mailing Address
First Line : 150 S WALL ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-3233
Country : US
Telephone Number : 541-435-7200
Fax Number : 541-888-0025
Provider Business Practice Location Address
First Line : 150 S WALL ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-3233
Country : US
Telephone Number : 541-435-7200
Fax Number : 541-888-0025
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : DAVON LORENZO SMITH
Credential :
Telephone Number : 541-294-0595
Provider Enumeration Date : 11/13/2006
Last Update Date : 11/26/2025

Similar Medicare Providers

1225013485 — DR. BASIL PITTENGER MD
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax:
1679523971 — LEANN JEAN WILLIS WELCH NP
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax: 541-888-0025
1831144674 — DR. PAUL C VITT DO
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax: 541-888-0025
1639232978 — LAURA FRANKLIN FNP
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax:
1619175635 — ALFREDO J VELEZ M.D.
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax:
1548456031 — DR. LARY PARKER STIEGLITZ M.D.
Practice Location Address:
150 S WALL ST
COOS BAY, OR
97420-3233
Practice Phone: 541-435-7200
Practice Fax: 541-888-0025

Directions to “CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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