| Integrated Medicine Group Llc | |
|
163 Ne 102nd Ave Building V Portland OR 97220-4169 | |
| (503) 257-3327 | |
| (503) 257-3374 |
| Full Name | Integrated Medicine Group Llc |
|---|---|
| Speciality | General Practice |
| Location | 163 Ne 102nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Christy C Heitsch (OWNER ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 5032573327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Medicine Group Llc 163 Ne 102nd Ave Building V Portland OR 97220-4169 Ph: (503) 257-3327 | Integrated Medicine Group Llc 163 Ne 102nd Ave Building V Portland OR 97220-4169 Ph: (503) 257-3327 |
| NPI Number | 1033249404 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 02/21/2008 |
| Medicare PECOS PAC ID | 1951397660 |
|---|---|
| Medicare Enrollment ID | O20040420001433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033249404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Oregon) | Primary |
| Provider Name | Tammy L Russell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1073701058 PECOS PAC ID: 2860580891 Enrollment ID: I20071108000592 |
| Provider Name | Lara R Lahman |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639340524 PECOS PAC ID: 6901984350 Enrollment ID: I20080424000720 |
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