Basic Information
| Provider Information | |||||||||
| NPI: | 1508895459 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORBIT MEDICAL OF PORTLAND INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TIBRO MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W GERMANTOWN PIKE STE 250 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012555202 | ||||||||
| FaxNumber: | 8014659998 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 HERITAGE PARK BLVD STE 200E | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840415645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012555202 | ||||||||
| FaxNumber: | 8014659998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCGEE | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6468800473 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 717096 | OR | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.