Provider Demographics
NPI:1558425165
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 1:650 W SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4761
Practice Address - Country:US
Practice Address - Phone:208-552-3113
Practice Address - Fax:208-552-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDME174332B00000X
332BC3200X, 332BP3500X, 332BX2000X, 335E00000X
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
ID002324711Medicaid
ID002324711Medicaid