County of Lake

Primary specialty

State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X

Legal business name

COUNTY OF LAKE

Doing business as

Lake County Public Health

Practice address

100 N D St
Suite 100
Lakeview, OR 97630-1540

Phone

(541) 947-6045

Fax

(541) 947-4563

NPI assigned

Sep 6, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary L Wilkie, RN, BSN

Title

Administrator

Phone

(541) 947-6045

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• Lake County Public Health Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1376646380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N D ST",
            "address_2": "SUITE 100",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301540",
            "telephone_number": "541-947-6045",
            "fax_number": "541-947-4563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N D ST",
            "address_2": "SUITE 100",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301540",
            "telephone_number": "541-947-6045",
            "fax_number": "541-947-4563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILKIE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-947-6045",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OR",
            "license": "93-60023202",
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "01358700",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP PIN",
            "identifier": "097360",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP FAMILY PLANNING PIN",
            "identifier": "320989",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP PROVIDERS",
            "identifier": "320989",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake County Public Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robin Lee Callaghan
• Judy Goodroad Clarke, REGISTERED NURSE
• Spencer A. Clarke, M.D.
• Iris Contreras, CHW
• Tina Ann Corey, M.S.W., L.C.S.W.
• Dallin A Degraffenried, DDS
• Jennafer Rose Deidrich, FAMILY PEER SUPPORT
• Desiree Renee Deroche
• Rosanne Fitzgerald, FNP-BC
• Nicole Alicia Forbes

• State or Local Public Health Clinic/Center in Lakeview, OR
• Providers in Lakeview, OR by specialty
• State or Local Public Health Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.