Provider Demographics
NPI:1568475408
Name:DEACON'S MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:DEACON'S MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-397-3345
Mailing Address - Street 1:118 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111
Mailing Address - Country:US
Mailing Address - Phone:509-397-3345
Mailing Address - Fax:509-397-2966
Practice Address - Street 1:118 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111
Practice Address - Country:US
Practice Address - Phone:509-397-3345
Practice Address - Fax:509-397-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601678679332B00000X, 332BD1200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9041856Medicaid
ID805724000Medicaid
WA9009283Medicaid
WA9041864Medicaid
WA9041864Medicaid
0348240001Medicare NSC
WA9041864Medicaid