Healthcare Provider Details

I. General information

NPI: 1285178210
Provider Name (Legal Business Name): FOOTHILLS MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE AVE SE STE A130
SALEM OR
97301-0074
US

IV. Provider business mailing address

8440 SE SUNNYBROOK BLVD STE 208
CLACKAMAS OR
97015-5781
US

V. Phone/Fax

Practice location:
  • Phone: 503-496-5239
  • Fax: 503-343-6554
Mailing address:
  • Phone: 503-496-5239
  • Fax: 503-343-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1687801-4
License Number StateOR

VIII. Authorized Official

Name: BRADY NELSON
Title or Position: PRESIDENT
Credential:
Phone: 503-496-5239