Organization
KITTITAS MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIK MICKELSON (MANAGER)
(509) 929-3000
Entity
Organization
Contact information
Practice address
709 S MAIN ST, ELLENSBURG, WA 98926-3640
(509) 929-3000
(509) 834-7414
Mailing address
709 S MAIN ST, ELLENSBURG, WA 98926-3640
(509) 929-3000
(509) 834-7414
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
09/01/2015
Last updated
02/01/2021
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