Healthcare Provider Details

I. General information

NPI: 1053084384
Provider Name (Legal Business Name): PACIFIC CREST INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W STEWART AVE STE 104
MEDFORD OR
97501-3663
US

IV. Provider business mailing address

229 W STEWART AVE STE 104
MEDFORD OR
97501-3663
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-1118
  • Fax: 541-488-6409
Mailing address:
  • Phone: 541-488-1118
  • Fax: 541-488-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM PRESS POWELL
Title or Position: PHYSICIAN/PRESIDENT
Credential: DO
Phone: 541-488-1118