Interstate Medical Group Llc is a
Clinic/center - Medical Specialty based in Portland, Oregon. Interstate Medical Group Llc is licensed to practice in * (Not Available) (license number ) and their current practice location is
17221 Se Division St, Portland, Oregon. It can be reached at their office (for appointments etc.) via phone at
(503) 760-0778.
NPI number for Interstate Medical Group Llc is 1932839776 and their current mailing address is 17221 Se Division St, Portland, Oregon. Interstate Medical Group Llc
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1932839776.
Healthcare Provider's Profile
| Full Name | Interstate Medical Group Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Medical Specialty |
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| Location | 17221 Se Division St, Portland, Oregon |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1932839776
- Provider Enumeration Date: 06/14/2022
- Last Update Date: 08/24/2022
Medical Identifiers
Medical identifiers for Interstate Medical Group Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1932839776 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 225700000X | Massage Therapist | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Interstate Medical Group Llc is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Interstate Medical Group Llc
17221 Se Division St,
Portland, OR 97236-1240
Ph: (503) 760-0778 | Interstate Medical Group Llc
17221 Se Division St,
Portland, OR 97236-1240
Ph: (503) 760-0778 |
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