Provider Demographics
NPI:1194921148
Name:SAFFRON'S SPECIALIZED MEDICAL, INC
Entity type:Organization
Organization Name:SAFFRON'S SPECIALIZED MEDICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAFFRON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMF
Authorized Official - Phone:503-351-3974
Mailing Address - Street 1:13215 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6963
Mailing Address - Country:US
Mailing Address - Phone:503-351-3974
Mailing Address - Fax:360-256-1616
Practice Address - Street 1:13215 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE C4
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6963
Practice Address - Country:US
Practice Address - Phone:503-351-3974
Practice Address - Fax:360-256-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602735515332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602735515OtherUBI
WA6032400001Medicare NSC