Provider Demographics
NPI:1790882496
Name:RKSO LLC
Entity Type:Organization
Organization Name:RKSO LLC
Other - Org Name:MILL PLAIN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-253-4367
Mailing Address - Street 1:416 NE 87TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1930
Mailing Address - Country:US
Mailing Address - Phone:360-253-4367
Mailing Address - Fax:360-213-1602
Practice Address - Street 1:416 NE 87TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1930
Practice Address - Country:US
Practice Address - Phone:360-253-4367
Practice Address - Fax:360-213-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00058058332B00000X, 332BX2000X, 332BP3500X, 335E00000X, 3336C0003X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056516Medicaid
WA6023550Medicaid
WA4928226OtherNCPDP
WA9056516Medicaid
WA4928226OtherNCPDP