YE OLDE COBBLER NPI 1700076585

NPI Information

NPI: 1700076585
Provider Name: YE OLDE COBBLER
Classification: Durable Medical Equipment & Medical Supplies - 332BC3200X
Entity Type: Organization

Specialization: Customized Equipment

Address:
30605 SW MAGNOLIA AVE
WILSONVILLE, OR
ZIP 97070
Phone: (503) 682-0354
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YE OLDE COBBLER is a customized equipment durable medical equipment medical supplies in Wilsonville, OR. YE OLDE COBBLER NPI is 1700076585. The provider is registered as an organization entity type.

The provider's business location address is:

30605 SW MAGNOLIA AVE
WILSONVILLE, OR
ZIP 97070-757
Phone: (503) 682-0354

The provider's authorized official is Richard A Filonczuk .
The authorized official title is Owner/ Operator and has the following contact phone number (503) 682-0354.

The enumeration date for this NPI number is 7/27/2007 and was last updated on 1/17/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332BC3200X	Durable Medical Equipment & Medical Supplies	Customized Equipment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0412070001	MEDICARE NSC	OREGON
2	160655	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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