Provider Demographics
NPI:1104029743
Name:PREMIER BRACES
Entity Type:Organization
Organization Name:PREMIER BRACES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCRIMSHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-751-1780
Mailing Address - Street 1:3415 QUAILWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1749
Mailing Address - Country:US
Mailing Address - Phone:509-751-1780
Mailing Address - Fax:509-751-8771
Practice Address - Street 1:1366 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2332
Practice Address - Country:US
Practice Address - Phone:509-751-1780
Practice Address - Fax:509-751-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602329359332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5165640001Medicare NSC