Healthcare Provider Details

I. General information

NPI: 1942502794
Provider Name (Legal Business Name): INTEGRATED JOINT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW GREENBURG RD 4 LINCOLN CENTER, SUITE 125
TIGARD OR
97223-5470
US

IV. Provider business mailing address

10250 SW GREENBURG RD STE 115
TIGARD OR
97223-5461
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-6783
  • Fax: 971-327-6734
Mailing address:
  • Phone: 503-719-6783
  • Fax: 971-327-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL RIGGS
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 503-582-8283