Provider Demographics
NPI:1346483393
Name:WALLOWA VALLEY HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:WALLOWA VALLEY HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:WARNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-432-0100
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-0881
Mailing Address - Country:US
Mailing Address - Phone:541-432-0100
Mailing Address - Fax:541-432-0100
Practice Address - Street 1:83365 JOSEPH HIGHWAY
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846
Practice Address - Country:US
Practice Address - Phone:541-432-0100
Practice Address - Fax:541-432-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNPC-0003237332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies