Healthcare Provider Details

I. General information

NPI: 1427346055
Provider Name (Legal Business Name): SIMPLE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MYRTLE AVE
ENUMCLAW WA
98022-3552
US

IV. Provider business mailing address

718 GRIFFIN AVE # 84
ENUMCLAW WA
98022-3418
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-1509
  • Fax: 360-825-1508
Mailing address:
  • Phone: 360-825-1509
  • Fax: 360-825-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOHN A DEITCHLER
Title or Position: OWNER
Credential:
Phone: 425-432-5034