Organization
EVERGREEN PROSTHETICS AND ORTHOTICS, LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up