Healthcare Provider Details

I. General information

NPI: 1306785654
Provider Name (Legal Business Name): COQUILLE VALLEY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E 5TH ST STE A
COQUILLE OR
97423-1755
US

IV. Provider business mailing address

940 E 5TH ST
COQUILLE OR
97423-1666
US

V. Phone/Fax

Practice location:
  • Phone: 541-396-3111
  • Fax: 541-824-1702
Mailing address:
  • Phone: 541-396-3101
  • Fax: 541-824-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY MICHAEL LANG
Title or Position: CEO
Credential:
Phone: 541-396-3101