Provider Demographics
NPI:1861661241
Name:INTEGRAL HEALTH PC
Entity Type:Organization
Organization Name:INTEGRAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-235-3767
Mailing Address - Street 1:2950 SE STARK ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3082
Mailing Address - Country:US
Mailing Address - Phone:503-235-3767
Mailing Address - Fax:503-236-9537
Practice Address - Street 1:2950 SE STARK ST STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3082
Practice Address - Country:US
Practice Address - Phone:503-235-3767
Practice Address - Fax:503-236-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO14108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR109189Medicare PIN