NPIMap

Organization Active NPI

Coquille Indian Tribe

  • Clinic/Center
  • Coos Bay, OR
National Provider Identifier
1376592287
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COQUILLE INDIAN TRIBE
Practice address
630 Miluk Dr
Coos Bay, OR 97420-7728
Phone
(541) 888-9494
Fax
(541) 888-4435
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Authorized official

Name
Charise Rich
Title
Billing Manager
Phone
(541) 888-9494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X OR Primary

Addresses

Primary practice location

630 Miluk Dr
Coos Bay, OR 97420-7728

Mailing address

PO Box 3190
Coos Bay, OR 97420-0407
Phone (541) 888-9494

Other identifiers 2

IdentifierTypeStateIssuer
165031MedicaidOR
261Q00000XOtherORTAXONOMY

Other names 1

  • Ko-Kwel Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, TX3 enrollments
Opioid treatment program
Medicare-enrolled since May 26, 2026

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040511000663 OR Part B Supplier - Clinic/Group Practice 6002805330 Receives reassigned benefits from 26 practitioners
Practice locations: Coos Bay, OR; Eugene, OR
O20210805000460 TX Part B Supplier - Clinic/Group Practice 6002805330 Receives reassigned benefits from 20 practitioners
Practice locations: Coos Bay, OR
O20250729000300 TX MDPP Supplier - in-Person MDPP Supplier 6002805330 Practice locations: Coos Bay, OR

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
38D0913043Ko-Kwel Wellness Center630 Miluk Dr, Coos Bay, OR 97420Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory

Locations

630 Miluk Dr
Coos Bay, OR 97420
Phone (541) 756-0904

2401 River Rd
Eugene, OR 97404
Phone (541) 726-4699

3050 Tremont St
North Bend, OR 97459

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1376592287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3190",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974200407",
            "telephone_number": "541-888-9494",
            "fax_number": "541-888-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MILUK DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974207728",
            "telephone_number": "541-888-9494",
            "fax_number": "541-888-4435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COQUILLE INDIAN TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "CHARISE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "541-888-9494"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165031",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "261Q00000X",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ko-Kwel Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coos Bay, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; 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.