Healthcare Provider Details

I. General information

NPI: 1528113982
Provider Name (Legal Business Name): AVADA OF OREGON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12724 SE STARK STREET, BUILDING H
PORTLAND OR
97233
US

IV. Provider business mailing address

12724 SE STARK STREET, BUILDING H
PORTLAND OR
97233
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-3131
  • Fax: 503-253-2895
Mailing address:
  • Phone: 503-253-3131
  • Fax: 503-253-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE W BARLOW
Title or Position: CEO
Credential:
Phone: 502-253-9802