Healthcare Provider Details

I. General information

NPI: 1548618069
Provider Name (Legal Business Name): LINDSLEY AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S TAVERNER DR
RIDGEFIELD WA
98642-7802
US

IV. Provider business mailing address

PO BOX 1264
RIDGEFIELD WA
98642-0015
US

V. Phone/Fax

Practice location:
  • Phone: 360-903-1508
  • Fax:
Mailing address:
  • Phone: 360-903-1508
  • Fax: 360-326-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDI00001197
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberDI00001197
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License NumberDI00001197
License Number StateWA

VIII. Authorized Official

Name: MR. DAVID D LINDSLEY
Title or Position: CEO
Credential: RD
Phone: 360-903-1508