Organization
CARROLL SMITH
Active
Other names
Active for Life
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARROLL DEAN SMITH (OWNER)
(503) 693-9380
Entity
Organization
Contact information
Practice address
448 S 1ST AVE, STE# 300, HILLSBORO, OR 97123-3952
(503) 693-9380
(503) 693-9270
Mailing address
PO BOX 571, HILLSBORO, OR 97123-0571
(503) 693-9380
(503) 693-9270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269587
—
OR
Enumeration date
07/08/2005
Last updated
11/02/2010
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