Provider Demographics
NPI:1972790426
Name:OR- MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:OR- MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEDZHIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-245-9940
Mailing Address - Street 1:628 N RIVERSIDE AVE
Mailing Address - Street 2:STE. E
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4654
Mailing Address - Country:US
Mailing Address - Phone:541-245-9940
Mailing Address - Fax:541-245-9941
Practice Address - Street 1:628 N RIVERSIDE AVE
Practice Address - Street 2:STE. E
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4654
Practice Address - Country:US
Practice Address - Phone:541-245-9940
Practice Address - Fax:541-245-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6030540001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6030540001Medicare NSC