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General NPI Number Information
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NPI Number | 1386981165
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Entity Type | Organization
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Legal Business Name | MDW INNOVATIONS LLC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 1960 S ARIZONA AVE APT B
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City | YUMA
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State | AZ
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Zip | 85364-5784
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Country | US
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Telephone | 928-613-2240
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1775
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City | YUMA
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State | AZ
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Zip | 85366-2381
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Country | US
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Telephone | 928-613-2240
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MR. MICAH DEAN WHITLOW
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Credential |
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Telephone | 928-613-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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