Healthcare Provider Details

I. General information

NPI: 1558439208
Provider Name (Legal Business Name): OREGON ORTHOTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W 5TH AVE
DENVER CO
80204-5105
US

IV. Provider business mailing address

911 MAIN ST STE 100
OREGON CITY OR
97045-1853
US

V. Phone/Fax

Practice location:
  • Phone: 720-858-1111
  • Fax: 720-858-7052
Mailing address:
  • Phone: 503-765-5081
  • Fax: 503-765-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number399419
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TIM O'NEILL
Title or Position: PRESIDENT
Credential:
Phone: 503-407-5408