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Organization
COUNTY OF POLK
Active
Organization
COUNTY OF POLK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG P. HANSEN (ADMINISTRATIVE OFFICER)
(503) 623-8173
Entity
Organization
Contact information
Practice address
182 SW ACADEMY STREET, SUITE 302, DALLAS, OR 97338-1922
(503) 623-8175
(503) 831-3499
Mailing address
182 SW ACADEMY STREET, SUITE 302, DALLAS, OR 97338-1922
(503) 623-8175
(503) 831-3499
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261QA0005X
Ambulatory Family Planning Facility
—
NULL
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/10/2006
Last updated
06/23/2015
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