OrganizationActive
Interstate Medical Group LLC
NPI 1932839776 · Medical Specialty Clinic/Center · Portland, OR
Provider details
- NPI number
- 1932839776
- Entity type
- Organization
- Primary specialty
- Medical Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Michael Logiudice, Owner(503) 339-7351
Specialties & taxonomies
Ambulatory Health Care Facilities
- Massage Therapist225700000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Chiropractor111N00000X
Chiropractic Providers
- Multi-Specialty Clinic/Center261QM1300X
Ambulatory Health Care Facilities
Practice location
17221 Se Division St
Portland, OR 97236-1240
Phone: (503) 760-0778
Fax: (503) 760-0753
Approximate (ZIP-level) locationGet directions
Mailing address
17221 Se Division St
Portland, OR 97236-1240
Registry dates
- Enumerated
- 2022-06-14
- Last updated
- 2022-08-24
- Certified
- 2022-08-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.