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NPI Code Detail

MEDICARE: ROOT & BLOOM INTEGRATIVE HEALTH

MEDICARE: ROOT & BLOOM INTEGRATIVE HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1922965011
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOT & BLOOM INTEGRATIVE HEALTH
Provider Business Mailing Address
First Line : 5441 S MACADAM AVE STE R
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3822
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 505 NW 9TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3578
Country : US
Telephone Number : 503-308-9363
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : KIARA CORDES
Credential :
Telephone Number : 541-480-3186
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ROOT & BLOOM INTEGRATIVE HEALTH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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