Polk County-Dept of Administration
Organization Active NPI Public Health or Welfare Agency · Balsam Lake, WI
NPI 1295964435 · NPPES record last updated Aug 14, 2013
Key facts
- NPI
- 1295964435
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- POLK COUNTY-DEPT OF ADMINISTRATION
- Practice address
- 100 Polk County PLZ
Ste 1801
Balsam Lake, WI 54810-9071 - Phone
- (715) 485-8500
- Fax
- (715) 485-8500
- NPI assigned
- Jul 9, 2009
- Organization subpart
- No
Authorized official
- Name
- Mrs. Gretchen Sampson
- Title
- Director
- Phone
- (715) 485-8500
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 6
Practitioners 4
-
Kevin J Montague, MS, LPC, LSAC, LSW
-
Kelly L Henry, MSW, LISW-S
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Polk County-Dept of Administration |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jan 1, 1966 Jan 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131021000226 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 4587560586 | Practice locations: Balsam Lake, WI |
National Provider Directory
- Tax ID family
- Polk County Public HLTH
Locations
220 Scholl Ct
Amery, WI 54001
Phone (715) 268-7107
100 Polk County Plz
Ste 50
Balsam Lake, WI 54810
Phone (715) 485-8400
100 Polk County Plz
Ste 1801
Balsam Lake, WI 54810
Phone (715) 485-8500
100 Polk County Plz
Ste 180
Balsam Lake, WI 54810
Phone (715) 485-8500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
100 Polk County PLZ
Ste 1801
Balsam Lake, WI 54810-9071
Mailing address
100 Polk County PLZ
Ste 180
Balsam Lake, WI 54810-9071
Phone (715) 485-8500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41850000 | Medicaid | WI |
Other names
- POLK COUNTY HEALTH DEPT/HEALTHCHECK
Other providers in Balsam Lake, WI
- Polk County Dept of Administration
- Polk County Health Dept
- Polk County Health Dept
- Polk County Health Dept
- Polk County Health Dept PCC Unit
- Polk County-Dept of Administration
- Nicole A Ruetz
- Karen Rusch
- School District of Unity
- St. Croix Regional Medical Center
All providers in Balsam Lake, WI · Public Health or Welfare Agency in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.