Healthcare Provider Details

I. General information

NPI: 1689595977
Provider Name (Legal Business Name): MEDOVIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 SE 362ND AVE UNIT B4
BORING OR
97009-9741
US

IV. Provider business mailing address

10625 SE 362ND AVE UNIT B4
BORING OR
97009-9741
US

V. Phone/Fax

Practice location:
  • Phone: 971-314-2900
  • 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

VIII. Authorized Official

Name: ETHAN CHRISTOPHER PARKER
Title or Position: OWNER
Credential:
Phone: 971-314-2900