COW CREEK BAND OF UMPQUA TRIBE OF INDIANS NPI 1063502714

NPI Information

NPI: 1063502714
Provider Name: COW CREEK BAND OF UMPQUA TRIBE OF INDIANS

Doing Business As: COW CREEK HEALTH & WELLNESS CTR

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 38D0862023

Address:
2589 NW EDENBOWER BLVD
ROSEBURG, OR
ZIP 97471
Phone: (541) 672-8533
Get Directions

COW CREEK BAND OF UMPQUA TRIBE OF INDIANS is a federally qualified health center (fqhc) clinic center in Roseburg, OR. COW CREEK BAND OF UMPQUA TRIBE OF INDIANS NPI is 1063502714. The provider is registered as an organization entity type.
The provider Is Doing Business As Cow Creek Health & Wellness Ctr.

The provider's business location address is:

2589 NW EDENBOWER BLVD
ROSEBURG, OR
ZIP 97471-220
Phone: (541) 672-8533
Fax: (855) 670-1791

The provider's authorized official is Sharon A Stanphill .
The authorized official title is Chief Health Officer and has the following contact phone number (541) 672-8533.

The CLIA number assigned to this NPI record is 38D0862023 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2006 and was last updated on 11/19/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500745176	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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