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General NPI Number Information
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NPI Number | 1710915723
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Entity Type | Organization
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Legal Business Name | LORRAINE SURGICAL SUPPLY OF WEST VIRGINIA INC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 99 EDGINGTON LANE
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City | WHEELING
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State | WV
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Zip | 26003
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Country | US
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Telephone | 304-243-1904
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Fax | 304-242-1587
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Provider Business Mailing Address
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Address Line | 99 EDGINGTON LANE
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City | WHEELING
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State | WV
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Zip | 26003
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Country | US
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Telephone | 304-243-1904
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Fax | 304-242-2587
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Authorized Official
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Title or Position | LEGAL
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Name | MR. RENDI MANN-STADT
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Credential |
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Telephone | 888-345-1780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 057397
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License Number State | WV
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