Organization Active NPI

Probrace, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Vancouver, WA
National Provider Identifier
1003019142
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
602726221 Issued in WA
Legal business name
PROBRACE, INC.
Practice address
11802 NE 65TH St Ste 101
Vancouver, WA 98662-5521
Phone
(800) 586-4403
Fax
(800) 586-4403
NPI assigned
Jun 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peg Leland
Title
Officer
Phone
(360) 556-0431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 602726221 WA Primary

Addresses

Primary practice location

11802 NE 65TH St Ste 101
Vancouver, WA 98662-5521

Mailing address

11802 NE 65TH St Ste 101
Vancouver, WA 98662-5521
Phone (800) 586-4403

Other identifiers 1

IdentifierTypeStateIssuer
0225913OtherWAWA LABOR & INDUSTRIES

National Provider Directory

National Provider Directory

Locations

11802 NE 65th St
Ste 101
Vancouver, WA 98662
Phone (800) 586-4403

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1003019142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11802 NE 65TH ST STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986625521",
            "telephone_number": "800-586-4403",
            "fax_number": "800-586-4403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11802 NE 65TH ST STE 101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986625521",
            "telephone_number": "800-586-4403",
            "fax_number": "800-586-4403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROBRACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "LELAND",
        "authorized_official_first_name": "PEG",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "360-556-0431"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "602726221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "0225913",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.