Provider Demographics
NPI:1104203488
Name:DOUGLAS MEDICAL EQUIPMENT SUPPLY, LLC
Entity Type:Organization
Organization Name:DOUGLAS MEDICAL EQUIPMENT SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABCT COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TORVIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-464-4492
Mailing Address - Street 1:2674 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2214
Mailing Address - Country:US
Mailing Address - Phone:541-756-9016
Mailing Address - Fax:541-756-9017
Practice Address - Street 1:2674 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2214
Practice Address - Country:US
Practice Address - Phone:541-756-9016
Practice Address - Fax:541-756-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR500643-94332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies