NPIMap

Coos County Oregon

Organization Active NPI Clinic/Center · Coos Bay, OR

NPI 1811981053 · NPPES record last updated May 22, 2025

Key facts

NPI
1811981053
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
COOS COUNTY OREGON
Practice address
281 Laclair Street
Coos Bay, OR 97420
Phone
(541) 266-6700
Fax
(541) 888-8726
NPI assigned
Sep 2, 2005
Organization subpart
Yes
Parent organization (as reported)
COOS COUNTY

Authorized official

Name
Dawn Renee Broughton
Title
Accounting Supervisor
Phone
(541) 266-6716

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 4

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

Practitioners 36

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

View all 36

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040818001343 OR Part B Supplier - Clinic/Group Practice 1759353071 Receives reassigned benefits from 24 practitioners
Practice locations: Coos Bay, OR

National Provider Directory

Tax ID family
Coos County Mental Heal (5 organizations share this tax ID)
Part of
Coos County Mental Heal

Locations

281 Laclair St
Coos Bay, OR 97420
Phone (541) 266-6700

1975 McPherson St
Ste 1
North Bend, OR 97459
Phone (541) 751-2400

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101YM0800X OR
Clinic/Center 261Q00000X Yes
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X OR
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Health Maintenance Organization 302R00000X OR

Addresses

Primary practice location

281 Laclair Street
Coos Bay, OR 97420

Mailing address

281 Laclair Street
Coos Bay, OR 97420
Phone (541) 266-6700

Other identifiers

IdentifierTypeStateIssuer
500500169MedicaidOR
500602110MedicaidOR

Other names

  • Coos Health & Wellness Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 22, 2025.

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1811981053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 LACLAIR STREET",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-266-6700",
            "fax_number": "541-888-8726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 LACLAIR STREET",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "97420",
            "telephone_number": "541-266-6700",
            "fax_number": "541-888-8726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOS COUNTY OREGON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOS COUNTY",
        "enumeration_date": "2005-09-02",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ACCOUNTING SUPERVISOR",
        "authorized_official_telephone_number": "541-266-6716"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500500169",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500602110",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coos Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coos Bay, OR

All providers in Coos Bay, OR · Clinic/Center in Oregon

Sources for this page

Verify at the official NPI Registry.