Organization
COOS COUNTY OREGON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN BROUGHTON (ACCOUNTING SUPERVISOR)
(541) 266-6716
Entity
Organization
Contact information
Practice address
281 LACLAIR STREET, COOS BAY, OR 97420
(541) 266-6700
Mailing address
281 LACLAIR STREET, COOS BAY, OR 97420
(541) 266-6700
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
OR
251K00000X
Public Health or Welfare Agency
Primary
092007202N7
OR
261QA0005X
Ambulatory Family Planning Facility
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045174
—
OR
05
—
097386
—
OR
05
—
320077
—
OR
01
—
R0000PHCLT
MASS IMMUNIZATION ROSTER BILLING
OR
Enumeration date
12/21/2006
Last updated
05/21/2025
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