Provider Demographics
NPI:1083364749
Name:BRISTOL ADVANCED ILLNESS MANAGEMENT - OREGON, L.L.C.
Entity Type:Organization
Organization Name:BRISTOL ADVANCED ILLNESS MANAGEMENT - OREGON, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-640-3231
Mailing Address - Street 1:2002 TIMBERLOCH PL STE 150A
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1198
Mailing Address - Country:US
Mailing Address - Phone:281-899-8470
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL WAY STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7004
Practice Address - Country:US
Practice Address - Phone:541-844-0151
Practice Address - Fax:541-656-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty