Healthcare Provider Details

I. General information

NPI: 1043752694
Provider Name (Legal Business Name): JOSEPH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 NE 219TH AVE
GRESHAM OR
97030-8419
US

IV. Provider business mailing address

348 NE 219TH AVE
GRESHAM OR
97030-8419
US

V. Phone/Fax

Practice location:
  • Phone: 971-322-7737
  • Fax:
Mailing address:
  • Phone: 971-322-7737
  • 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: MRS. SHAWNA L JOSEPH
Title or Position: OWNER
Credential:
Phone: 971-322-7737