Provider Demographics
NPI:1699143057
Name:PERFORMANCE MODALITIES INC
Entity type:Organization
Organization Name:PERFORMANCE MODALITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:LUANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:NAC
Authorized Official - Phone:206-569-4601
Mailing Address - Street 1:19625 62ND AVE S
Mailing Address - Street 2:SUITE A101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1103
Mailing Address - Country:US
Mailing Address - Phone:253-852-5612
Mailing Address - Fax:253-852-0427
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:SUITE 203B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-466-3191
Practice Address - Fax:253-466-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109680001Medicare NSC