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General NPI Number Information
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NPI Number | 1528924479
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Entity Type | Organization
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Legal Business Name | PETERSON MEDICAL LLC
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 4415 W CLEARWATER AVE STE NO11
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City | KENNEWICK
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State | WA
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Zip | 99336-2246
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Country | US
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Telephone | 509-783-7501
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Fax | 509-980-7062
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Provider Business Mailing Address
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Address Line | PO BOX 5885
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City | KENNEWICK
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State | WA
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Zip | 99336-0798
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Country | US
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Telephone | 760-750-0645
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Fax | 509-980-7062
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOSHUA PEKELO MARQUARDT
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Credential |
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Telephone | 760-750-0645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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