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Active NPI 1134204340 Organization (Entity Type 2)

Gresham Internal Medicine Clinic

Internal Medicine • Gresham, OR

About Gresham Internal Medicine Clinic NPI 1134204340 Summary

Gresham Internal Medicine Clinic is a verified healthcare organization specializing in Internal Medicine operating in Gresham, OR. Located at 24900 SE STARK ST STE 109, this facility provides patient care and medical services under National Provider Identifier (NPI) 1134204340.

Administrative operations and authorized compliance are overseen by John Custis (Owner/Partner).

The facility is associated with 6 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

24900 Se Stark St Ste 109

Gresham, OR 970303381

Telephone 5036671015
Fax 5036670406

Authorized Official Information

Authorized Contact Name

DR. John Custis , MD

Title / Role

Owner/partner

Official Telephone

5036671015

Facility Classifications & Specialties

Internal Medicine Primary Taxonomy

NUCC Taxonomy Code: 207R00000X

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

6 Linked

Clinical Nurse Specialist

Gresham, OR

View Practitioner Profile →

Physician Assistant - Medical

Gresham, OR

View Practitioner Profile →

Internal Medicine - Clinical Cardiac Electrophysiology

Gresham, OR

View Practitioner Profile →

Internal Medicine - Cardiovascular Disease

Gresham, OR

View Practitioner Profile →
Dr. Laura Flath , MD NPI 1780806125

Internal Medicine

Gresham, OR

View Practitioner Profile →

Internal Medicine - Interventional Cardiology

Gresham, OR

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active December 11, 2008

NPI status registered as active in NPPES database

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Updated Practice Location December 11, 2008

Registered at 24900 SE STARK ST STE 109, GRESHAM, OR 970303381 (Tel: 5036671015)

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Updated Business Mailing Address December 11, 2008

Registered at PO BOX 23200, PORTLAND, OR 972813200 (Tel: 5036671015)

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Organization / Clinic Name Updated December 11, 2008

Operating as GRESHAM INTERNAL MEDICINE CLINIC

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 11, 2008

Internal Medicine (License #01794 in OR)

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Initial NPI Registration & Enumeration October 26, 2006

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1134204340
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: October 26, 2006
Last Update: December 11, 2008

Mailing Address

Po Box 23200

Portland, OR 972813200

Phone: 5036671015

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.