| Organization Name: | AVAMERE MEDICAL SUPPLY LLC |
| NPI Number: | 1104829258 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD A. DILLON (OWNER/COO) |
| Mailing Address: | 25117 Sw Parkway Ave Ste F Wilsonville |
| State: | OR US |
| Postal Code: | 970709697 |
| Phone Number: | 5037832483 |
| Fax Number: | 5037832480 |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 01/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |