Healthcare Provider Details

I. General information

NPI: 1356126841
Provider Name (Legal Business Name): NORCO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 E MIRABEAU PKWY STE 500
SPOKANE VALLEY WA
99216-1450
US

IV. Provider business mailing address

1125 W AMITY RD
BOISE ID
83705-5412
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-9385
  • Fax:
Mailing address:
  • Phone: 208-336-1643
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GOTTS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 208-509-3088