Provider Demographics
NPI:1437250461
Name:CRAGON INC
Entity type:Organization
Organization Name:CRAGON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-253-8984
Mailing Address - Street 1:PO BOX 20458
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294-0458
Mailing Address - Country:US
Mailing Address - Phone:503-253-8984
Mailing Address - Fax:503-253-2094
Practice Address - Street 1:12035 NE GLENN WIDING DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9050
Practice Address - Country:US
Practice Address - Phone:503-253-8984
Practice Address - Fax:503-253-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR9039694OtherWASHINGTON MEDICAID
OR063169Medicaid
OR875018000OtherBLUE CROSS BLUE SHIELD
WA0058824OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA9039694Medicaid
OR9039694OtherWASHINGTON MEDICAID