Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
261QP2300X | |||
Cardiovascular Disease |
207RC0000X | 11 | Physician/Internal Medicine | |
Community Health |
261QC1500X | |||
Community/Behavioral Health |
251S00000X | |||
Dental Therapist |
125J00000X | |||
Federally Qualified Health Center (FQHC) |
261QF0400X | B4[14] | Federally Qualified Health Center | |
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
332800000X | 87 | All Other Suppliers |
| NPI # | 1780755454 |
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| LBN Legal business name | CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS | ||||||||||||||||
| Authorized official | DAVON SMITH - (CHIEF OPERATIONS OFFICER) | ||||||||||||||||
| Entity | Organization | ||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||
| Enumeration date | 11/13/2006 | ||||||||||||||||
| Last updated | 04/13/2026 - About 2 months ago | ||||||||||||||||
| Identifiers |
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