Provider Demographics
NPI:1063572881
Name:OREGON PEDORTHIC SERVICES, INC.
Entity type:Organization
Organization Name:OREGON PEDORTHIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCURTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-491-1723
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0154
Mailing Address - Country:US
Mailing Address - Phone:503-491-1723
Mailing Address - Fax:
Practice Address - Street 1:9900 SE WASHINGTON ST
Practice Address - Street 2:MALL 205, STE C-36
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2422
Practice Address - Country:US
Practice Address - Phone:503-491-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1070450001Medicare NSC