Provider Demographics
NPI:1215309497
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:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCURTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
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:503-489-0706
Practice Address - Street 1:10117 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE H
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-7708
Practice Address - Country:US
Practice Address - Phone:503-305-7254
Practice Address - Fax:503-489-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment