NPIMap

Organization Active NPI

Coquille Valley Health

  • Family Medicine Physician
  • Myrtle Point, OR
National Provider Identifier
1306623657
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COQUILLE VALLEY HEALTH
Practice address
345 8TH St
Myrtle Point, OR 97458-1214
Phone
(541) 824-0400
Fax
(541) 592-7497
NPI assigned
Sep 11, 2023
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey M Lang
Title
Ceo
Phone
(541) 396-3101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

345 8TH St
Myrtle Point, OR 97458-1214

Mailing address

PO Box 374
Coquille, OR 97423-0374
Phone (541) 396-3101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240910003766 OR Part B Supplier - Clinic/Group Practice 2567902182 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coquille, OR; Coos Bay, OR; Myrtle Point, OR

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2317642Coquille Valley Health-Myrtle Point Clinic345 8TH St, Myrtle Point, OR 97458Certificate of waiverJan 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coquille Valley Hosp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2699 N 17th St
Coos Bay, OR 97420
Phone (541) 266-3600

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1306623657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 374",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974230374",
            "telephone_number": "541-396-3101",
            "fax_number": "541-824-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 8TH ST",
            "city": "MYRTLE POINT",
            "state": "OR",
            "postal_code": "974581214",
            "telephone_number": "541-824-0400",
            "fax_number": "541-592-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COQUILLE VALLEY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-11",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "LANG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-396-3101"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Point, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.