Healthcare Provider Details

I. General information

NPI: 1164436085
Provider Name (Legal Business Name): REDMOND INTERNAL MEDICINE CLINIC,LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 NW 4TH STREET STE 201
REDMOND OR
97756-1680
US

IV. Provider business mailing address

1245 NW 4TH STREET STE 201
REDMOND OR
97756-1680
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-4545
  • Fax: 541-323-4546
Mailing address:
  • Phone: 541-323-4545
  • Fax: 541-323-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD19294/MD23086
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORELEI MCMILLIAN
Title or Position: OWNER
Credential: FNP
Phone: 541-323-4540