Healthcare Provider Details

I. General information

NPI: 1194137695
Provider Name (Legal Business Name): WASHINGTON MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 WRIGHT AVE
RICHLAND WA
99354-3011
US

IV. Provider business mailing address

1019 WRIGHT AVE
RICHLAND WA
99354-3011
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-3354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6034059860010001
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number6034059860010001
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number6034059860010001
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number6034059860010001
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number6034059860010001
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6034059860010001
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number6034059860010001
License Number StateWA

VIII. Authorized Official

Name: MRS. CHRISTINE LISA LEWIS
Title or Position: CEO
Credential:
Phone: 509-943-3354