Provider Demographics
NPI:1851626006
Name:ORBIT MEDICAL OF PORTLAND INC
Entity Type:Organization
Organization Name:ORBIT MEDICAL OF PORTLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-713-2020
Mailing Address - Street 1:716 E 4500 S
Mailing Address - Street 2:SUITE 260 S
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3080
Mailing Address - Country:US
Mailing Address - Phone:801-713-2020
Mailing Address - Fax:
Practice Address - Street 1:10150 SW NIMBUS AVE
Practice Address - Street 2:SUITE E-5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4337
Practice Address - Country:US
Practice Address - Phone:801-713-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR628389-91332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies