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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