Provider Demographics
NPI:1093737900
Name:TRI-CARE WHEEL CHAIR SERVICES INC
Entity Type:Organization
Organization Name:TRI-CARE WHEEL CHAIR SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAZOUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-267-2603
Mailing Address - Street 1:432 SE 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1630
Mailing Address - Country:US
Mailing Address - Phone:503-267-2603
Mailing Address - Fax:503-252-4246
Practice Address - Street 1:432 SE 91ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1630
Practice Address - Country:US
Practice Address - Phone:503-267-2603
Practice Address - Fax:503-252-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235117Medicaid
OR4091020001Medicare NSC