NPIMap

Organization Active NPI

Northeast Iowa Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Decorah, IA
National Provider Identifier
1710933445
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
NONE Issued in IA
Legal business name
NORTHEAST IOWA MENTAL HEALTH CENTER
Practice address
905 Montgomery St
Decorah, IA 52101-2325
Phone
(563) 382-3649
Fax
(563) 382-8183
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
Mrs. Marcia Oltrogge, MANPI 1194885533
Title
Executive Director
Phone
(563) 382-3649

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NONE IA Primary

Addresses

Primary practice location

905 Montgomery St
Decorah, IA 52101-2325

Mailing address

PO Box 349
905 Montgomery St.
Decorah, IA 52101-0349
Phone (563) 382-3649

Other identifiers 1

IdentifierTypeStateIssuer
0074559MedicaidIA

Other names 1

  • Northeast Iowa Behavioral Health, Inc. Doing business as

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 80

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000839 IA Part B Supplier - Clinic/Group Practice 1355230475 Receives reassigned benefits from 19 practitioners
Practice locations: Decorah, IA; Oelwein, IA

National Provider Directory

National Provider Directory

Locations

905 Montgomery St
Decorah, IA 52101
Phone (563) 382-3649

36 S Frederick Ave
Oelwein, IA 50662
Phone (319) 283-5774

500 S Pine St
West Union, IA 52175

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1710933445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "address_2": "905 MONTGOMERY ST.",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521010349",
            "telephone_number": "563-382-3649",
            "fax_number": "563-382-8183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "563-382-3649",
            "fax_number": "563-382-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST IOWA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "OLTROGGE",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "563-382-3649",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IA",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074559",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Iowa Behavioral Health, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decorah, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; 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.