Organization Name: | PORTNEUF BRACE COMPANY, LLC |
NPI Number: | 1447687520 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID VANORDEN (MANAGER) |
Mailing Address: | 560 Memorial Dr Ste C Pocatello |
State: | ID US |
Postal Code: | 832014073 |
Phone Number: | 2082423931 |
Fax Number: | 8553191499 |
NPI Enumeration Date: | 10/03/2013 |
NPI Last Update Date: | 10/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | DME22523 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
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 |