Provider Demographics
NPI:1730223967
Name:COQUILLE VALLEY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:COQUILLE VALLEY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-396-3101
Mailing Address - Street 1:940 E. FIFTH ST.
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423
Mailing Address - Country:US
Mailing Address - Phone:541-396-3101
Mailing Address - Fax:541-396-1783
Practice Address - Street 1:940 EAST FIFTH STREET
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423
Practice Address - Country:US
Practice Address - Phone:541-396-3101
Practice Address - Fax:541-396-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR140875282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR381312Medicaid
OR381312Medicare Oscar/Certification
OR0000ZGBDCMedicare PIN