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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 Specialty Code Provider Type

Customized Equipment

332BC3200X 87 All Other Suppliers
 

Prosthetic/Orthotic Supplier

335E00000X 51 Medical Supply Company with Orthotist
Indicates primary specialty

NPI Profile & details for PACIFIC FOOTWEAR COMPANY, INC.

NPI # 1558316851
LBN Legal business name PACIFIC FOOTWEAR COMPANY, INC.
Authorized official KEVIN CLARKE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 05/24/2006
Last updated 04/22/2025 - More than a year ago
Identifiers
ID Medicaid 806954600
OR Medicaid 297988
WA Medicaid 9054784
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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