Provider Demographics
NPI:1942020326
Name:SOUTHERN COOS HEALTH DISTRICT
Entity type:Organization
Organization Name:SOUTHERN COOS HEALTH DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO - AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-544-6592
Mailing Address - Street 1:900 11TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9114
Mailing Address - Country:US
Mailing Address - Phone:541-347-1325
Mailing Address - Fax:541-347-6297
Practice Address - Street 1:900 11TH ST SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9114
Practice Address - Country:US
Practice Address - Phone:541-347-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN COOS HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy