Organization
COUNTY OF TILLAMOOK
Active
Other names
Tillamook County Health Department - Cloverdale Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARLENE L PUTMAN JD (ADMINISTRATOR)
(503) 842-3900
Entity
Organization
Contact information
Practice address
34325 HIGHWAY 101 S, CLOVERDALE, OR 97112-9400
(503) 842-3900
(503) 842-3903
Mailing address
PO BOX 489, TILLAMOOK, OR 97141-0489
(503) 842-3900
(503) 842-3903
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116488
NORIDIAN
OR
05
—
128756
—
OR
Enumeration date
06/30/2008
Last updated
07/30/2019
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