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OREGON PEDORTHIC SERVICES

Suppliers Prosthetic/Orthotic Supplier

Provider NPI: 1033112636

Organization Information:
Organization Name:  OREGON PEDORTHIC SERVICES
Authorized Official:  RODRICK FORD STOCKWELL  OFFICE MANAGER  503-491-1723

Practice Location:
9932 NE HALSEY ST  PORTLAND, OR 97220-4474 US
Tel: 503-491-1723  Fax: 503-489-0706

Business Mailing Address:
PO BOX 608  GRESHAM, OR 97030-0154 US
Tel: 503-491-1723  Fax: 503-489-0706

NPI Information:
NPI: 1033112636
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X335E00000XSuppliers
Prosthetic/Orthotic Supplier
OR=========
X332B00000XSuppliers
Durable Medical Equipment & Medical Supplies
OR

Other Provider Identifiers:

IssuerNumberStateType
207923OR05




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