Provider Demographics
NPI:1336704071
Name:INTEGRATED JOINT SPECIALISTS LLC
Entity Type:Organization
Organization Name:INTEGRATED JOINT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HTTPS://WWW.FACEBOOK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-719-6783
Mailing Address - Street 1:10250 SW GREENBURG RD STE 115
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5461
Mailing Address - Country:US
Mailing Address - Phone:503-719-6783
Mailing Address - Fax:971-327-6734
Practice Address - Street 1:10250 SW GREENBURG RD STE 115
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5461
Practice Address - Country:US
Practice Address - Phone:037-196-7835
Practice Address - Fax:971-327-6734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED JOINT SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1942502794Medicaid
OR1942502794OtherGROUP NPI FOR OR CLINIC