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General NPI Number Information
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NPI Number | 1881024107
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Entity Type | Organization
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Legal Business Name | OREGON PEDORTHIC SERVICES INC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 2530 SE BURNSIDE RD
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City | GRESHAM
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State | OR
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Zip | 97080-1245
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Country | US
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Telephone | 503-491-1723
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 608
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City | GRESHAM
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State | OR
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Zip | 97030-0154
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Country | US
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Telephone | 503-491-1723
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Fax |
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Authorized Official
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Title or Position | OWNER AND PRESIDENT
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Name | DOUG P MCCURTAIN
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Credential |
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Telephone | 503-491-1723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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