1013278399 NPI number — BARBARA J MANTHA

Table of content: (NPI 1013278399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013278399 NPI number — BARBARA J MANTHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA J MANTHA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOME MEDICAL EQUIPMENT AND SUPPLIES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013278399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1173
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-265-5581
Provider Business Mailing Address Fax Number:
541-265-5264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 SW COAST HWY STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365-5051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-265-5581
Provider Business Practice Location Address Fax Number:
541-265-5264
Provider Enumeration Date:
06/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MANTHA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JUNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-265-5581

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  NPC-0001856 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6695420001 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500646786 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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