Provider Demographics
NPI:1851325625
Name:RONMAX ENT INC
Entity Type:Organization
Organization Name:RONMAX ENT INC
Other - Org Name:ACTIVE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-899-2077
Mailing Address - Street 1:195 EAST E STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9246
Mailing Address - Country:US
Mailing Address - Phone:541-899-2077
Mailing Address - Fax:541-899-1795
Practice Address - Street 1:195 EAST E STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9246
Practice Address - Country:US
Practice Address - Phone:541-899-2077
Practice Address - Fax:541-899-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210224Medicaid
OR1020950001Medicare NSC