Provider Demographics
NPI:1164568747
Name:BURIS MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:BURIS MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:BURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-397-4635
Mailing Address - Street 1:119 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1803
Mailing Address - Country:US
Mailing Address - Phone:509-397-4635
Mailing Address - Fax:509-397-2960
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1803
Practice Address - Country:US
Practice Address - Phone:509-397-4635
Practice Address - Fax:509-397-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60Z002951332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9043142Medicaid
WA9043142Medicaid