Provider Demographics
NPI:1841466869
Name:INSTITUTE FOR TRADITIONAL MEDICINE
Entity type:Organization
Organization Name:INSTITUTE FOR TRADITIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-224-7224
Mailing Address - Street 1:2348 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-224-7224
Mailing Address - Fax:503-224-1345
Practice Address - Street 1:2348 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-224-7224
Practice Address - Fax:503-224-1345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTE FOR TRADITIONAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0688175F00000X
ORAC00078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty