Provider Demographics
NPI:1669838470
Name:AUTONOMIC INNOVATIONS, LLC
Entity Type:Organization
Organization Name:AUTONOMIC INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-780-9221
Mailing Address - Street 1:6464 SW BORLAND RD
Mailing Address - Street 2:STE C3
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8876
Mailing Address - Country:US
Mailing Address - Phone:971-252-6411
Mailing Address - Fax:971-252-6412
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:STE C3
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:971-252-6411
Practice Address - Fax:971-252-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies