Provider Demographics
NPI:1336387372
Name:CRAGON INC.
Entity Type:Organization
Organization Name:CRAGON INC.
Other - Org Name:CRARY SHOE MFG. CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:503-253-8984
Mailing Address - Street 1:PO BOX 20458
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294-0458
Mailing Address - Country:US
Mailing Address - Phone:503-253-8984
Mailing Address - Fax:503-253-8984
Practice Address - Street 1:9900 SW GREENBURG RD
Practice Address - Street 2:SUITE 190
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:503-670-7600
Practice Address - Fax:503-670-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0910810002Medicare NSC