Organization
PACIFIC FOOTWEAR COMPANY, INC.
Active
Other names
Priority Footwear & Pedorthic Services
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN W CLARKE (PRESIDENT)
(503) 524-9656
Entity
Organization
Contact information
Practice address
10240 SW NIMBUS AVE, SUITE L1, PORTLAND, OR 97223
(503) 524-9656
(503) 524-8397
Mailing address
10240 SW NIMBUS AVE, SUITE L1, PORTLAND, OR 97223
(503) 524-9656
(503) 524-8397
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297988
—
OR
05
—
806954600
—
ID
05
—
9054784
—
WA
Enumeration date
05/24/2006
Last updated
04/22/2025
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