Ye Olde Cobbler

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

YE OLDE COBBLER

Practice address

30605 SW Magnolia Ave
Wilsonville, OR 97070-6757

Phone

(503) 682-0354

NPI assigned

Jul 27, 2007

Organization subpart

No

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

Authorized official

Name

Richard A Filonczuk

Title

Owner/ Operator

Phone

(503) 682-0354

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1700076585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 482",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970700482",
            "telephone_number": "503-682-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30605 SW MAGNOLIA AVE",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970706757",
            "telephone_number": "503-682-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YE OLDE COBBLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-27",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "FILONCZUK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/ OPERATOR",
        "authorized_official_telephone_number": "503-682-0354"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160655",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Windfield Village
• Jeanene Teresa Wold, LMT
• Tezeta H Workie, COTA
• Katelyn Beck Wright, RPH
• Carole E Yazaji, PHARMD
• Carrie Anne Young, OTRL
• Kaitlyn Alexandra Young
• Nicole Young, LMT
• Cristina E Zadroga, PHD
• Cecilia Zavala Almanza

• Customized Equipment (DME) in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Customized Equipment (DME) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.