Provider Demographics
NPI:1770683880
Name:PAUL E. GERVAIS
Entity Type:Organization
Organization Name:PAUL E. GERVAIS
Other - Org Name:MEDICAL SUPPLY OF CENTRAL OREGON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-504-7700
Mailing Address - Street 1:356 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2201
Mailing Address - Country:US
Mailing Address - Phone:541-504-7700
Mailing Address - Fax:541-504-9170
Practice Address - Street 1:356 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2201
Practice Address - Country:US
Practice Address - Phone:541-504-7700
Practice Address - Fax:541-504-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269868Medicaid
OR68560OtherCOIHS
OR68560OtherCOIHS