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Organization
CRAGON INC
Active
Organization
CRAGON INC
Active
Other names
CRARY SHOES, Crary Shoe Mfg Co
Organization subpart
No
Provider details
NPI number
Authorized official
MEREDITH JOHANSON (VICE PRESIDENT)
(503) 253-8984
Entity
Organization
Contact information
Practice address
12035 NE GLENN WIDING DR, PORTLAND, OR 97220-9050
(503) 253-8984
(503) 253-2094
Mailing address
PO BOX 20458, PORTLAND, OR 97294-0458
(503) 253-8984
(503) 253-2094
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0058824
DEPARTMENT OF LABOR AND INDUSTRIES
WA
05
—
063169
—
OR
01
—
875018000
BLUE CROSS BLUE SHIELD
OR
01
—
9039694
WASHINGTON MEDICAID
OR
05
—
9039694
—
WA
Enumeration date
09/25/2006
Last updated
07/12/2024
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