Healthcare Provider Details

I. General information

NPI: 1780755454
Provider Name (Legal Business Name): CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WALL ST
COOS BAY OR
97420-3233
US

IV. Provider business mailing address

150 S WALL ST
COOS BAY OR
97420-3233
US

V. Phone/Fax

Practice location:
  • Phone: 541-435-7200
  • Fax: 541-888-0025
Mailing address:
  • Phone: 541-435-7200
  • Fax: 541-888-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVON LORENZO SMITH
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 541-294-0595