1275809600 NPI number — INTEGRAL PSYCHIATRY PC

Table of content: (NPI 1275809600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275809600 NPI number — INTEGRAL PSYCHIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRAL PSYCHIATRY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275809600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3439 NE SANDY BLVD
Provider Second Line Business Mailing Address:
PMB 375
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-1959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-284-8841
Provider Business Mailing Address Fax Number:
503-282-3302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 NW WALL ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-330-0304
Provider Business Practice Location Address Fax Number:
541-382-6576
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHOPRA
Authorized Official First Name:
GURPREET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-330-0304

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  MD28897 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500604044 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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