Basic Information
| Provider Information | |||||||||
| NPI: | 1730223967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COQUILLE VALLEY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 E. FIFTH ST. | ||||||||
| Address2: | |||||||||
| City: | COQUILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413963101 | ||||||||
| FaxNumber: | 5413961783 | ||||||||
| Practice Location | |||||||||
| Address1: | 940 EAST FIFTH STREET | ||||||||
| Address2: | |||||||||
| City: | COQUILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413963101 | ||||||||
| FaxNumber: | 5413961783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | LANG | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5413963101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 140875 | OR | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 381312 | 05 | OR | MEDICAID |