Provider Demographics
NPI:1538281662
Name:NORCO, INC
Entity Type:Organization
Organization Name:NORCO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE VICE PRESIDENT MEDICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-336-1643
Mailing Address - Street 1:1125 W AMITY RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5412
Mailing Address - Country:US
Mailing Address - Phone:208-336-1643
Mailing Address - Fax:
Practice Address - Street 1:1911 MEADOWLARK LN
Practice Address - Street 2:SUITE A
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6822
Practice Address - Country:US
Practice Address - Phone:406-494-1349
Practice Address - Fax:406-494-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0209525OtherMEDICAID HOME AND COMMUNITY BASED SERVICES
MT419356OtherMEDICAID CFC PERS
MT056-9920Medicaid
MT0209525OtherMEDICAID HOME AND COMMUNITY BASED SERVICES