NPIMap

Organization Active NPI

County of Tillamook

  • Public Health Dentistry
  • Tillamook, OR
National Provider Identifier
1417568668
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Legal business name
COUNTY OF TILLAMOOK
Practice address
805 Ivy Ave Ste B
Tillamook, OR 97141-3758
Phone
(503) 842-3900
NPI assigned
Aug 12, 2020
Organization subpart
Yes
Parent organization
COUNTY OF TILLAMOOKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Marlene L Putman, JD
Title
Administrator
Phone
(503) 842-3922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0001X Primary

Addresses

Primary practice location

805 Ivy Ave Ste B
Tillamook, OR 97141-3758

Mailing address

PO Box 489
Tillamook, OR 97141-0489
Phone (503) 842-3900

Other identifiers 1

IdentifierTypeStateIssuer
128756MedicaidOR

Other names 1

  • Tillamook County Health Department - Dental Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413000702 OR Part B Supplier - Clinic/Group Practice 3173411287 Receives reassigned benefits from 10 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cloverdale, OR; Rockaway Beach, OR; Tillamook, OR

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
County of Tillamook6 organizations share this tax ID, including this one
Part of
County of Tillamook

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 Ivy Ave
Ste B
Tillamook, OR 97141
Phone (503) 842-2356

NPI Registry JSON

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1417568668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 489",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971410489",
            "telephone_number": "503-842-3900",
            "fax_number": "503-842-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 IVY AVE STE B",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413758",
            "telephone_number": "503-842-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF TILLAMOOK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF TILLAMOOK",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "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": "503-842-3922",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128756",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tillamook County Health Department - Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tillamook County Health Department - Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tillamook, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.