Healthcare Provider Details

I. General information

NPI: 1598908360
Provider Name (Legal Business Name): MEDIUS MEDICAL CONCEPTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SW 5TH AVE SUITE 1100
PORTLAND OR
97204-3604
US

IV. Provider business mailing address

111 SW 5TH AVE SUITE 1100
PORTLAND OR
97204-3604
US

V. Phone/Fax

Practice location:
  • Phone: 503-459-5500
  • Fax: 503-459-5515
Mailing address:
  • Phone: 503-459-5500
  • Fax: 503-459-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD M HAGAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 503-459-5500