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General NPI Number Information
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NPI Number | 1710303169
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Entity Type | Organization
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Legal Business Name | CONVALESCENT EQUIPMENT AND SUPPLY CO. INC.
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 1251 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3854
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Country | US
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Telephone | 877-552-3726
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Fax | 425-774-0420
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Provider Business Mailing Address
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Address Line | 1251 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3854
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Country | US
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Telephone | 877-552-3726
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Fax | 425-774-0420
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P CORDOVA
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Credential |
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Telephone | 425-774-0083
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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 | 600561377
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License Number State | WA
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