MEDICARE: DOUGLAS MEDICAL EQUIPMENT SUPPLY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	500643-94	OR

General Provider Information

NPI Number	:	1104203488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS MEDICAL EQUIPMENT SUPPLY, LLC

Provider Business Mailing Address
First Line	:	2674 BROADWAY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2214
Country	:	US
Telephone Number	:	541-756-9016
Fax Number	:	541-756-9017

Provider Business Practice Location Address
First Line	:	2674 BROADWAY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2214
Country	:	US
Telephone Number	:	541-756-9016
Fax Number	:	541-756-9017

Authorized Official
Title or Position	:	ABCT COO
Name	:	MRS. MICHELE E TORVIK
Credential	:
Telephone Number	:	541-464-4492

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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