Active NPI
Coquille Valley Health
- Physical Medicine & Rehabilitation Physician
- Coos Bay, OR
National Provider Identifier
1730908773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- Legal business name
- COQUILLE VALLEY HEALTH
- Practice address
- 2645 N 17TH St
Coos Bay, OR 97420-2134 - Phone
- (541) 266-3658
- NPI assigned
- Oct 7, 2024
- Last updated
- Oct 14, 2024
- Organization subpart
- Yes
- Parent organization
- COQUILLE VALLEY HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffrey Michael Lang
- Title
- Ceo
- Phone
- (541) 396-3101
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | Primary |
Addresses
Primary practice location
2645 N 17TH St
Coos Bay, OR 97420-2134
Mailing address
PO Box 374
Coquille, OR 97423-0374
Phone (541) 396-7984
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
National Provider Directory
National Provider Directory- Tax ID family
- Coquille Valley Health
- Part of
- Coquille Valley Health
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Coquille, OR
- NPI 1306785654
-
- Medicare Defined Swing Bed Hospital Unit
- Coquille, OR
- NPI 1831070093
-
- Critical Access Hospital
- Coquille, OR
- NPI 1932080199
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1728864000000",
"number": "1730908773",
"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": "541-396-7984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2645 N 17TH ST",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202134",
"telephone_number": "541-266-3658"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COQUILLE VALLEY HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COQUILLE VALLEY HEALTH",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A",
"authorized_official_last_name": "LANG",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "541-396-3101"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.