1184887523 NPI number — COUNTY OF TILLAMOOK

Table of content: (NPI 1184887523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184887523 NPI number — COUNTY OF TILLAMOOK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF TILLAMOOK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TILLAMOOK COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184887523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 PACIFIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TILLAMOOK
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97141-3926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-842-3900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 S HIGHWAY 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKAWAY BEACH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97136-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-355-2700
Provider Business Practice Location Address Fax Number:
503-355-2702
Provider Enumeration Date:
07/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PUTMAN
Authorized Official First Name:
MARLENE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
503-842-3900

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  MD11776 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116488 . This is a "NORIDIAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 128756 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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