Provider Demographics
NPI:1982880738
Name:PDX MEDICAL SUPPLY
Entity Type:Organization
Organization Name:PDX MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DRAGOSH
Authorized Official - Middle Name:G
Authorized Official - Last Name:POSTEVKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-777-9996
Mailing Address - Street 1:8044 SE HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5148
Mailing Address - Country:US
Mailing Address - Phone:503-777-9996
Mailing Address - Fax:503-777-9996
Practice Address - Street 1:8044 SE HAROLD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5148
Practice Address - Country:US
Practice Address - Phone:503-777-9996
Practice Address - Fax:503-777-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR663332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies