EARTH SOURCE MEDICINE NPI 1164952495

NPI Information

NPI: 1164952495
Provider Name: EARTH SOURCE MEDICINE
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
Doing Business As: ASTORIA INTEGRATIVE FAMILY MEDICINE
Address: 1490 COMMERCIAL ST STE 200
ASTORIA, OR
ZIP 97103
Phone: (503) 741-3636

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NPI Details

EARTH SOURCE MEDICINE is a primary care clinic center in Astoria, OR. EARTH SOURCE MEDICINE NPI is 1164952495. The provider is registered as an organization entity type.
The provider Is Doing Business As Astoria Integrative Family Medicine.

The provider's business location address is:

1490 COMMERCIAL ST STE 200
ASTORIA, OR
ZIP 97103-800
Phone: (503) 741-3636

The provider's authorized official is Carolyn Iacullo Nygaard .
The authorized official title is Owner and has the following contact phone number (503) 741-3636.

The enumeration date for this NPI number is 6/19/2017 and was last updated on 7/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center			OREGON	No
2	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500642404	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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