NPIMap

Organization Active NPI

Confederated Tribes of Coos, Lower Umpqua & Siuslaw Indians

Doing business as Three Rivers Health Center - Coos Bay

  • Primary Care Clinic/Center
  • Coos Bay, OR
National Provider Identifier
1780755454
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
Doing business as
Three Rivers Health Center - Coos Bay
Practice address
150 S Wall St
Coos Bay, OR 97420-3233
Phone
(541) 435-7200
Fax
(541) 888-0025
NPI assigned
Nov 13, 2006
Last updated
Apr 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Davon Lorenzo Smith
Title
Chief Operations Officer
Phone
(541) 294-0595

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU
Community/Behavioral Health Agency 251S00000X NU
Dental Therapist 125J00000X NU

Addresses

Primary practice location

150 S Wall St
Coos Bay, OR 97420-3233

Mailing address

150 S Wall St
Coos Bay, OR 97420-3233
Phone (541) 435-7200

Other practice location 1

250 Hull St
Coos Bay, OR 97420-3038
Phone (541) 435-7200

Other identifiers 4

IdentifierTypeStateIssuer
RP-0003971OtherOROREGON BOARD OF PHARMACY - RETAIL DRUG OUTLET
165383MedicaidOR
500838955MedicaidOR
RP-0003971-CSOtherOROREGON BOARD OF PHARMACY - CONTROLLED SUBSTANCE

Other names 2

  • Three Rivers Health Center - Coos Bay Doing business as
  • Confederated Tribes of Coos, Lower Umpqua & Siuslaw Indians Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240611004652 TX Part B Supplier - Clinic/Group Practice 1658813183 Receives reassigned benefits from 4 practitioners
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
38D2301190Three Rivers Health Center150 S Wall St, Coos Bay, OR 97420Certificate of waiverMar 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
Confederated Tribes of Coos2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

150 S Wall St
Coos Bay, OR 97420
Phone (541) 435-7200

250 Hull St
Coos Bay, OR 97420
Phone (541) 435-7200

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1780755454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S WALL ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974203233",
            "telephone_number": "541-435-7200",
            "fax_number": "541-888-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S WALL ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974203233",
            "telephone_number": "541-435-7200",
            "fax_number": "541-888-0025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Hull St",
            "address_purpose": "LOCATION",
            "city": "Coos Bay",
            "state": "OR",
            "postal_code": "974203038",
            "country_code": "US",
            "telephone_number": "541-435-7200",
            "fax_number": "541-888-0025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVON",
        "authorized_official_middle_name": "LORENZO",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "541-294-0595"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF PHARMACY - RETAIL DRUG OUTLET",
            "identifier": "RP-0003971",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165383",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500838955",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF PHARMACY - CONTROLLED SUBSTANCE",
            "identifier": "RP-0003971-CS",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Center - Coos Bay",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Three Rivers Health Center - Coos Bay",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Confederated Tribes of Coos, Lower Umpqua & Siuslaw Indians",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 13, 2026; 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.