Provider Demographics
NPI:1679907976
Name:MEDROCK, INC.
Entity Type:Organization
Organization Name:MEDROCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-719-7775
Mailing Address - Street 1:PO BOX 40266
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97240-0266
Mailing Address - Country:US
Mailing Address - Phone:503-719-7775
Mailing Address - Fax:
Practice Address - Street 1:6812 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1648
Practice Address - Country:US
Practice Address - Phone:503-719-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies