Integrative Pediatrics LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD15689 Issued in OR

Legal business name

INTEGRATIVE PEDIATRICS LLC

Practice address

11790 SW Barnes Rd
Suite 140
Portland, OR 97225-5934

Phone

(503) 643-2100

Fax

(503) 643-7300

NPI assigned

Jun 30, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Norman Thomas, M.D.

Title

President

Phone

(503) 643-2100

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1194987206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD",
            "address_2": "BLG. A, SUITE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255934",
            "telephone_number": "503-643-2100",
            "fax_number": "503-643-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD",
            "address_2": "SUITE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255934",
            "telephone_number": "503-643-2100",
            "fax_number": "503-643-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-643-2100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD15689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.