Provider Demographics
NPI:1306044623
Name:UNIMEDCORNER
Entity Type:Organization
Organization Name:UNIMEDCORNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHCHERBAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-224-7999
Mailing Address - Street 1:1418 SW MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1911
Mailing Address - Country:US
Mailing Address - Phone:503-224-7999
Mailing Address - Fax:503-224-8222
Practice Address - Street 1:1418 SW MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1911
Practice Address - Country:US
Practice Address - Phone:503-224-7999
Practice Address - Fax:503-224-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5942440001Medicare NSC