Provider Demographics
NPI:1407887151
Name:ALPHADRY MEDICAL, LLC
Entity Type:Organization
Organization Name:ALPHADRY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:ISSAC
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-522-8078
Mailing Address - Street 1:1211 EDGEWATER ST NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4073
Mailing Address - Country:US
Mailing Address - Phone:503-375-9193
Mailing Address - Fax:503-296-5855
Practice Address - Street 1:1211 EDGEWATER ST NW
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4073
Practice Address - Country:US
Practice Address - Phone:503-375-9193
Practice Address - Fax:503-296-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4620950001Medicare ID - Type Unspecified