Provider Demographics
NPI:1679681787
Name:NORTHERN MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:NORTHERN MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-935-4020
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0810
Mailing Address - Country:US
Mailing Address - Phone:509-935-4020
Mailing Address - Fax:509-935-4975
Practice Address - Street 1:332902 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-5165
Practice Address - Country:US
Practice Address - Phone:509-447-5332
Practice Address - Fax:509-447-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055393Medicaid
WA9040809Medicaid
WA9055377Medicaid
ID805398300Medicaid
WA7123698Medicaid
WA9055385Medicaid
WA9055385Medicaid