Healthcare Provider Details

I. General information

NPI: 1912522053
Provider Name (Legal Business Name): DURABLE MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 168TH ST E STE 102
PUYALLUP WA
98375-2513
US

IV. Provider business mailing address

9909 168TH ST E STE 102
PUYALLUP WA
98375-2513
US

V. Phone/Fax

Practice location:
  • Phone: 253-961-6880
  • Fax: 888-856-3201
Mailing address:
  • Phone: 253-961-6880
  • Fax:

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JON NORDQUIST
Title or Position: PRESIDENT
Credential: DC
Phone: 253-961-6880