| Organization Name: | OREGON PEDORTHIC SERVICES |
| NPI Number: | 1376546978 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RODRICK FORD STOCKWELL (OFFICE MANAGER) |
| Mailing Address: | 12214 Se Mill Plain Blvd Ste 102 Vancouver |
| State: | WA US |
| Postal Code: | 986846019 |
| Phone Number: | 3608851930 |
| Fax Number: | 3608851930 |
| NPI Enumeration Date: | 05/27/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OR |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |