INTEGRATED MEDICINE GROUP LLC NPI 1679508212

NPI Information

NPI: 1679508212
Provider Name: INTEGRATED MEDICINE GROUP LLC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
163 NE 102ND AVE BLDG V
PORTLAND, OR
ZIP 97220
Phone: (503) 257-3327
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INTEGRATED MEDICINE GROUP LLC is a general practice in Portland, OR. INTEGRATED MEDICINE GROUP LLC NPI is 1679508212. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

163 NE 102ND AVE BLDG V
PORTLAND, OR
ZIP 97220-169
Phone: (503) 257-3327
Fax: (503) 257-3374

The provider's authorized official is Christy Heitsch .
The authorized official title is Clinic Director and has the following contact phone number (503) 257-3327.

The enumeration date for this NPI number is 7/12/2006 and was last updated on 1/22/2008.

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	208D00000X	General Practice		MD11610	OREGON	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	R117633	MEDICARE PIN	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: 11/14/2023

NPI Synchronization or Removal

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