Healthcare Provider Details

I. General information

NPI: 1790326882
Provider Name (Legal Business Name): PERFORMANCE MODALITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21606 SE STARK ST
GRESHAM OR
97030-2028
US

IV. Provider business mailing address

PO BOX 94307
SEATTLE WA
98124-6607
US

V. Phone/Fax

Practice location:
  • Phone: 866-687-4463
  • Fax: 877-414-2727
Mailing address:
  • Phone: 253-852-5612
  • Fax: 253-854-4891

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 TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LUANA MICHELE HALL
Title or Position: DIRECTOR OF COMPLIANCE
Credential: NAC
Phone: 206-569-4601