Provider Demographics
NPI:1407811789
Name:OREGON ARTIFICIAL LIMB CO.
Entity Type:Organization
Organization Name:OREGON ARTIFICIAL LIMB CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:DAYBREAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-231-4876
Mailing Address - Street 1:21 NE SEVENTH AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2907
Mailing Address - Country:US
Mailing Address - Phone:503-231-4876
Mailing Address - Fax:503-232-0256
Practice Address - Street 1:21 NE SEVENTH AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2907
Practice Address - Country:US
Practice Address - Phone:503-231-4876
Practice Address - Fax:503-232-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR145375Medicaid
0447760001Medicare ID - Type Unspecified