Provider Demographics
NPI:1841237427
Name:HARRELL MEDICAL, INC
Entity type:Organization
Organization Name:HARRELL MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-778-8873
Mailing Address - Street 1:1224 TYNDALL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5874
Mailing Address - Country:US
Mailing Address - Phone:877-788-8734
Mailing Address - Fax:503-922-0692
Practice Address - Street 1:333 S STATE ST
Practice Address - Street 2:SUITE V 451
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3932
Practice Address - Country:US
Practice Address - Phone:877-788-8734
Practice Address - Fax:503-922-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1238410001Medicare ID - Type UnspecifiedCIGNA MEDICARE REGION D