Provider Demographics
NPI:1821206285
Name:INTERNAL MEDICINE ASSOCIATES OF REDMOND
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF REDMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRETHEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-548-7134
Mailing Address - Street 1:236 NW KINGWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1324
Mailing Address - Country:US
Mailing Address - Phone:541-548-7134
Mailing Address - Fax:541-548-7196
Practice Address - Street 1:236 NW KINGWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1324
Practice Address - Country:US
Practice Address - Phone:541-548-7134
Practice Address - Fax:541-548-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG25695Medicare UPIN
ORF19086Medicare UPIN
ORAO7518Medicare UPIN
ORP30769Medicare UPIN