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INTERSTATE MEDICAL GROUP LLC
NPI 1932839776
Clinic/Center - Medical Specialty in Portland, OR

Active since June 14, 2022
17221 SE DIVISION ST, PORTLAND, OR 97236(503) 760-0778(503) 760-0753 Get Directions Write a Review

NPPES record last updated: August 24, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Interstate Medical Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INTERSTATE MEDICAL GROUP LLC (NPI 1932839776) is a healthcare organization registered as a medical specialty in Portland, Oregon and active in the NPI registry since June 2022. The organization lists Michael Logiudice, Owner, as its authorized official.

NPPES Registry Identity

NPI1932839776
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameINTERSTATE MEDICAL GROUP LLC
Location Address17221 SE DIVISION STPortland, OR 97236-1240
Mailing Address17221 Se Division StPortland, OR 97236-1240 · (503) 760-0778 · Fax (503) 760-0753
Phone(503) 760-0778
Fax(503) 760-0753
Organization SubpartNo
Authorized OfficialMichael LogiudiceOwner · (503) 339-7351
Enumeration DateJune 14, 2022
Last NPPES UpdateAugust 24, 2022
NPPES CertifiedAugust 24, 2022
✔ NPI 1932839776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
Also ListedChiropractorTaxonomy 111N00000X
Also ListedMassage TherapistTaxonomy 225700000X
Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
17221 SE DIVISION ST, Portland, OR 97236
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDRE RAYMOND LAURIER JR. LMT
Massage Therapist
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 760-0778
DR. JEFFREY ALBING D.C.
Chiropractor
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 760-0778
STANISLAV KUKUSHKIN
Massage Therapist
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 760-0778
BORYS LEONIDOVYCH SMOLYANSKY LMT
Massage Therapist
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 760-0778
DIANA SHAPOVALOVA
Massage Therapist
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (971) 338-8542
ARTUR S SNEGUR LMT
Specialist
17221 SE DIVISION ST, STE. 21
PORTLAND, OR 97236
Multnomah County (503) 761-2110
PACIFIC CHIROPRACTIC & WELLNESS CENTER, LLC
Chiropractor
17221 SE DIVISION ST, STE 21
PORTLAND, OR 97236
Multnomah County (503) 760-0778
LINDA D BROWN L.M.T.
Massage Therapist
17221 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (206) 658-5357

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Interstate Medical Group LLC's NPI number?

The NPI number for Interstate Medical Group LLC is 1932839776. It was assigned to this organization in the NPPES registry on June 14, 2022.

Where is Interstate Medical Group LLC located?

Interstate Medical Group LLC is located at 17221 SE Division St, Portland, OR 97236. The listed phone number is (503) 760-0778.

What is Interstate Medical Group LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Interstate Medical Group LLC was last updated on August 24, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.