Organization
PACIFIC COAST MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAN D STUTZNEGGER (PRESIDENT)
(503) 338-0349
Entity
Organization
Contact information
Practice address
2158 EXCHANGE ST, STE 106, ASTORIA, OR 97103-3316
(503) 338-0349
(503) 338-6998
Mailing address
PO BOX 634, ASTORIA, OR 97103-0634
(503) 338-0349
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)
NPC-0001961
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500600821
—
OR
05
—
9046947
—
WA
Enumeration date
04/17/2007
Last updated
07/21/2016
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