Astoria Integrative Family Medicine
LBN: Earth Source Medicine
Astoria Integrative Family Medicine is an health care organization with primary practice located at 1490 Commercial St Ste 200 , Astoria OR 97103-3800. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Ambulatory Health Care Facilities / Primary Care. Ambulatory Health Care Facilities / Primary Care is the primary health care specialty.
Earth Source Medicine can be contacted via phone (503) 741-3636, or through Nygaard, Carolyn Iacullo via phone (503) 741-3636.
Contact Information
Primary practice address
1490 Commercial St Ste 200
Astoria OR 97103-3800
Phone: (503) 741-3636
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Clinic/Center | 261Q00000X | Oregon | |
| Ambulatory Health Care Facilities / Primary Care | 261QP2300X |
Profile Details
| NPI number | 1164952495 |
|---|---|
| LBN Legal business name | Earth Source Medicine |
| DBA Doing business as | Astoria Integrative Family Medicine |
| Authorized official | Nygaard, Carolyn Iacullo N.D |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jun 19th, 2017 |
| Last updated | Jul 6th, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164952495 | NPPES |
| Oregon | MEDICAID | 500642404 |
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