NPIMap

Organization Active NPI

Oregon Department of Corrections

  • Preferred Provider Organization
  • Tualatin, OR
National Provider Identifier
1659721397
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
L4861 Issued in OR
Legal business name
OREGON DEPARTMENT OF CORRECTIONS
Practice address
17734 SW Shasta TRL
Tualatin, OR 97062-8455
Phone
(503) 691-1718
NPI assigned
Jun 14, 2016
Last updated
Jun 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Authorized official

Name
Mr. Linn Rey Menzie, LCSWNPI 1326570326
Title
BHS Program Manager
Phone
(503) 280-6646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X L4861 OR Primary

Addresses

Primary practice location

17734 SW Shasta TRL
Tualatin, OR 97062-8455

Mailing address

17734 SW Shasta TRL
Tualatin, OR 97062-8455
Phone (503) 691-1718

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 12

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1659721397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17734 SW SHASTA TRL",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628455",
            "telephone_number": "503-691-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17734 SW SHASTA TRL",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628455",
            "telephone_number": "503-691-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON DEPARTMENT OF CORRECTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "MENZIE",
        "authorized_official_first_name": "LINN",
        "authorized_official_middle_name": "REY",
        "authorized_official_title_or_position": "BHS PROGRAM MANAGER",
        "authorized_official_telephone_number": "503-280-6646",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "L4861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; 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.