Healthcare Provider Details

I. General information

NPI: 1487921839
Provider Name (Legal Business Name): NORCO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 N 2ND E
REXBURG ID
83440-1620
US

IV. Provider business mailing address

PO BOX 15299
BOISE ID
83715-5299
US

V. Phone/Fax

Practice location:
  • Phone: 208-356-7913
  • Fax: 208-356-9532
Mailing address:
  • Phone: 208-336-1643
  • Fax: 208-343-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRENT SEWARD
Title or Position: EXECUTIVE VICE PRESIDENT, MEDICAL
Credential:
Phone: 208-336-1643