Provider Demographics
NPI:1437542693
Name:PERFORMANCE MODALITIES, INC.
Entity Type:Organization
Organization Name:PERFORMANCE MODALITIES, INC.
Other - Org Name:DBA PERFORMANCE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:LUANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-569-4601
Mailing Address - Street 1:19625 62ND AVE S
Mailing Address - Street 2:SUITE A101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1103
Mailing Address - Country:US
Mailing Address - Phone:866-687-4463
Mailing Address - Fax:253-852-0427
Practice Address - Street 1:777 N 5TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3080
Practice Address - Country:US
Practice Address - Phone:360-683-2650
Practice Address - Fax:360-683-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109680001OtherPRIMARY PTAN
WA1109680010Medicare NSC