Healthcare Provider Details

I. General information

NPI: 1154120699
Provider Name (Legal Business Name): RISEN MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 NE REVERE AVE STE 103
BEND OR
97701-4082
US

IV. Provider business mailing address

4709 SW BADGER CREEK DR
REDMOND OR
97756-6229
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-0820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TREVOR GOMEZ
Title or Position: OWNER
Credential:
Phone: 503-830-0855