CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS (NPI# 1780755454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780755454 |
| Entity Type | Organization |
| Organization Name | CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS |
| Practice Address |
1245 Fulton Ave Coos Bay OR 97420-2895 |
| Practice Telephone | 5418886433 |
| Practice Fax Number | 5418887505 |
| Mailing Telephone | 5418886433 |
| Mailing Fax Number | 5418887505 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MARK ALAN JOHNSTON (HHS DIRECTOR) |
| Authorized Official Telephone | 5418887515 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 165383 | 05 |
| Street Address |
1245 FULTON AVE |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-2895 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306332010 | Marissa Gardner | Technician, Other | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2018-07-05 |
| 1215451661 | Naomi Rachelle Petrie | Technician, Other | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2017-07-27 |
| 1962956904 | Shannon Michelle Schritter | Dental Hygienist | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2016-08-08 |
| 1396113007 | Sarah Ann Rodgers | Dentist | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2015-09-11 |
| 1518342179 | Daryl K Reavis | Dentist | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2015-07-24 |
| 1225229131 | Patricia Anne Peyton | Dental Hygienist | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2007-08-06 |
| 1053486696 | Robert Bruce Macy | Dentist | 1245 Fulton Ave, Coos Bay, OR 97420-2895 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144834375 | Geoffrey R Clive Dds LLC | Clinic/Center | 11082 Se Oak St, Milwaukie, OR 97222-6692 | 2020-09-04 |
| 1508416041 | Columbia River Dentistry-gresham, LLC | Clinic/Center | 1700 Nw Civic Dr Ste 320, Gresham, OR 97030-3774 | 2019-09-17 |
| 1063065068 | Portland Dental Smiles | Clinic/Center | 732 Sw 3rd Ave Ste 202, Portland, OR 97204-2409 | 2019-07-18 |
| 1104478619 | David A Allen Dds | Clinic/Center | 1059 Royal Ave, Medford, OR 97504-6127 | 2019-07-15 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1164080875 | Central Point Dental LLC | Clinic/Center | 12338 Se 143rd Pl, Happy Valley, OR 97086-6545 | 2019-05-29 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1558839498 | Kevin Prates Dds, PC | Clinic/Center | 1002 10th St Ste 1, Hood River, OR 97031-1564 | 2018-11-08 |
| 1063993749 | Roots Dental Stark LLC | Clinic/Center | 16338 Se Stark St, Portland, OR 97233-3958 | 2018-08-22 |
| 1528546330 | Christopher Brady Dmd LLC | Clinic/Center | 4707 Ne 102nd Ave Ste A, Portland, OR 97220-3393 | 2018-08-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.