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General NPI Number Information
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NPI Number | 1487014163
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERNAL MEDICINE GROUP, PC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 9555 SW BARNES RD STE 255
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City | PORTLAND
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State | OR
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Zip | 97225-6654
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Country | US
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Telephone | 503-908-1590
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Fax | 503-723-2862
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Provider Business Mailing Address
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Address Line | 9555 SW BARNES RD STE 255
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City | PORTLAND
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State | OR
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Zip | 97225-6654
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Country | US
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Telephone | 503-908-1590
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Fax | 503-723-2862
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | SARAH EDSON
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Credential |
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Telephone | 503-908-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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