Provider Demographics
NPI:1477762821
Name:WY EAST ENTERPRISES LLC
Entity Type:Organization
Organization Name:WY EAST ENTERPRISES LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED PEDORTHIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:503-653-8700
Mailing Address - Street 1:11211 SE 82ND AVE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7624
Mailing Address - Country:US
Mailing Address - Phone:503-653-8700
Mailing Address - Fax:503-653-8739
Practice Address - Street 1:11211 SE 82ND AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7624
Practice Address - Country:US
Practice Address - Phone:503-653-8700
Practice Address - Fax:503-653-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229276Medicaid
OR229276Medicaid
OR4075700001Medicare NSC