Provider Demographics
NPI:1316067614
Name:MEDSTAR INC
Entity type:Organization
Organization Name:MEDSTAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-778-8873
Mailing Address - Street 1:11830 KERR PKWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1223
Mailing Address - Country:US
Mailing Address - Phone:877-778-8873
Mailing Address - Fax:866-474-3686
Practice Address - Street 1:11830 KERR PKWY
Practice Address - Street 2:SUITE 370
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1223
Practice Address - Country:US
Practice Address - Phone:877-778-8873
Practice Address - Fax:866-474-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies