# COUNTY OF POLK

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710910781
- **Authorized official:** MR. GREG P. HANSEN (ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (503) 623-8173

## Contact information

- **Practice address:** 182 SW ACADEMY STREET, SUITE 302, DALLAS, OR 97338-1922
- **Practice address phone:** (503) 623-8175
- **Practice address fax:** (503) 831-3499
- **Mailing address:** 182 SW ACADEMY STREET, SUITE 302, DALLAS, OR 97338-1922
- **Mailing address phone:** (503) 623-8175
- **Mailing address fax:** (503) 831-3499

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 06/23/2015