Provider Demographics
NPI:1417094145
Name:SOUTHERN COOS HEALTH DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN COOS HEALTH DISTRICT
Other - Org Name:SOUTHERN COOS HOSPITAL & HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-347-2426
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:541-347-2426
Mailing Address - Fax:541-347-3923
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:541-347-2426
Practice Address - Fax:541-347-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR140809282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800004Medicaid
OR800004Medicaid