Organization
EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L O'NEILL CPO (OWNER)
(503) 407-5408
Entity
Organization
Contact information
Practice address
2850 SE POWELL VALLEY RD STE 104, GRESHAM, OR 97080-1495
(503) 660-3180
(503) 660-3180
Mailing address
911 MAIN ST STE 100, OREGON CITY, OR 97045-1853
(503) 765-5081
(971) 316-1553
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
681350
OR
332BC3200X
Customized Equipment (DME)
681350
OR
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278247
—
OR
Enumeration date
03/29/2007
Last updated
11/01/2023
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