Provider Demographics
NPI:1255651592
Name:NIC GROUP INC
Entity Type:Organization
Organization Name:NIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAUMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-235-5781
Mailing Address - Street 1:8383 NE SANDY BLVD STE 320DD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4968
Mailing Address - Country:US
Mailing Address - Phone:503-235-5781
Mailing Address - Fax:
Practice Address - Street 1:8383 NE SANDY BLVD STE 320DD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4968
Practice Address - Country:US
Practice Address - Phone:503-235-5781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty