Provider Demographics
NPI:1316012768
Name:SHAMROCK MEDICAL INC
Entity Type:Organization
Organization Name:SHAMROCK MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SCHWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-233-5055
Mailing Address - Street 1:3620 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1880
Mailing Address - Country:US
Mailing Address - Phone:503-233-5055
Mailing Address - Fax:503-234-6974
Practice Address - Street 1:3620 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1880
Practice Address - Country:US
Practice Address - Phone:503-233-5055
Practice Address - Fax:503-234-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082081000OtherREGENCE BLUE CROSS
OR207824Medicaid
0419800001Medicare ID - Type Unspecified