Provider Demographics
NPI:1770598526
Name:B & J CUSTOM DME, LLC.
Entity type:Organization
Organization Name:B & J CUSTOM DME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-982-8598
Mailing Address - Street 1:1335 N.PACIFIC HWY.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-3617
Mailing Address - Country:US
Mailing Address - Phone:503-982-8598
Mailing Address - Fax:503-982-8598
Practice Address - Street 1:1335 N. PACIFIC HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-3617
Practice Address - Country:US
Practice Address - Phone:503-982-8598
Practice Address - Fax:503-982-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR313656-95332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5786090001Medicare ID - Type Unspecified