Provider Demographics
NPI:1427346055
Name:SIMPLE MEDICAL, LLC
Entity type:Organization
Organization Name:SIMPLE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEITCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-432-5034
Mailing Address - Street 1:718 GRIFFIN AVE # 84
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3418
Mailing Address - Country:US
Mailing Address - Phone:360-825-1509
Mailing Address - Fax:360-825-1508
Practice Address - Street 1:1221 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3552
Practice Address - Country:US
Practice Address - Phone:360-825-1509
Practice Address - Fax:360-825-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-17
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies