National Provider Identifier Database

PACIFIC FOOTWEAR COMPANY INC
Customized Equipment


Contact Information

PACIFIC FOOTWEAR COMPANY, INC.
10240 SW NIMBUS AVE
SUITE L1
PORTLAND, OR97223
Phone: 503-524-9656
Fax: 503-524-8397
Website:
Specialty Taxonomy Code
* Customized Equipment 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X

* Indicates primary specialty

NPI Profile & details for PACIFIC FOOTWEAR COMPANY, INC.

NPI Number 1558316851
Legal business name
LBN
PACIFIC FOOTWEAR COMPANY, INC.
Authorized official KEVIN CLARKE - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 05/24/2006
Last updated 04/22/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • ID Medicaid: 806954600
  • OR Medicaid: 297988
  • WA Medicaid: 9054784

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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