Provider Demographics
NPI:1679571384
Name:KEEN MOBILITY COMPANY
Entity Type:Organization
Organization Name:KEEN MOBILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-285-9090
Mailing Address - Street 1:733 SW OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3712
Mailing Address - Country:US
Mailing Address - Phone:503-285-9090
Mailing Address - Fax:503-223-9488
Practice Address - Street 1:733 SW OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3712
Practice Address - Country:US
Practice Address - Phone:503-285-9090
Practice Address - Fax:503-223-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1167255-2332B00000X
CAIMP 143710332B00000X
CTMFG.UT.0001566.OR332B00000X
WVUT1566 WV FILE#1968332B00000X
VA14418332B00000X
NC321332B00000X
OKUT-1566-OR-O332B00000X
UTUT 1566 (OR)332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233141Medicaid
WA9055716Medicaid
WA9055716Medicaid