Healthcare Provider Details

I. General information

NPI: 1578908034
Provider Name (Legal Business Name): NATIONWIDE MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BELLEVUE ST SE STE. 120
SALEM OR
97301-3819
US

IV. Provider business mailing address

110 HICKORY ST NW
ALBANY OR
97321-1724
US

V. Phone/Fax

Practice location:
  • Phone: 503-485-2552
  • Fax: 503-485-2245
Mailing address:
  • Phone: 541-981-2837
  • Fax: 541-704-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberNPC-002999
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID SIEGEL
Title or Position: CEO/OWNER
Credential:
Phone: 818-338-3500