NPIMap

Organization Active NPI

Polk County Mental Health

  • Case Management Agency
  • Dallas, OR
National Provider Identifier
1639295694
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
251B00000X Issued in OR
Legal business name
POLK COUNTY MENTAL HEALTH
Practice address
182 SW Academy St Ste 304
Dallas, OR 97338-1900
Phone
(503) 623-9289
Fax
(503) 623-1874
NPI assigned
Mar 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Corina Isabel MartinezNPI 1053538355
Title
Services Coordinator
Phone
(503) 623-9289

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 251B00000X OR Primary

Addresses

Primary practice location

182 SW Academy St Ste 304
Dallas, OR 97338-1900

Mailing address

182 SW Academy St Ste 304
Dallas, OR 97338-1900
Phone (503) 623-9289

National Provider Directory

National Provider Directory
Tax ID family
Polk County Mental HLTH11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

182 SW Academy St
Ste 304
Dallas, OR 97338
Phone (503) 623-1886

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639295694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST STE 304",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381900",
            "telephone_number": "503-623-9289",
            "fax_number": "503-623-1874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST STE 304",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381900",
            "telephone_number": "503-623-9289",
            "fax_number": "503-623-1874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "CORINA",
        "authorized_official_middle_name": "ISABEL",
        "authorized_official_title_or_position": "SERVICES COORDINATOR",
        "authorized_official_telephone_number": "503-623-9289"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OR",
            "license": "251B00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

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

Verify at the official NPI Registry.