Provider Demographics
NPI:1548405301
Name:MULTI-MATERIAL IMPLANT, LLC
Entity Type:Organization
Organization Name:MULTI-MATERIAL IMPLANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:503-267-7955
Mailing Address - Street 1:7266 SW IRON HORSE ST.
Mailing Address - Street 2:ATT: MMI
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:502-267-7955
Mailing Address - Fax:888-361-0634
Practice Address - Street 1:7266 SW IRON HORSE ST
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8880
Practice Address - Country:US
Practice Address - Phone:503-267-7955
Practice Address - Fax:888-361-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR558368-95332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies