Provider Demographics
NPI:1184625014
Name:MEDIC REPAIR & SALES INC
Entity type:Organization
Organization Name:MEDIC REPAIR & SALES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-252-6133
Mailing Address - Street 1:2722 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3404
Mailing Address - Country:US
Mailing Address - Phone:425-252-6133
Mailing Address - Fax:425-258-6942
Practice Address - Street 1:2722 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3404
Practice Address - Country:US
Practice Address - Phone:425-252-6133
Practice Address - Fax:425-258-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
WA9045782332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA106183OtherL & I
WA9045782OtherMEDICAID OXYGEN
WA9041674Medicaid
WA1078060001Medicare ID - Type Unspecified