Provider Demographics
NPI:1093091555
Name:NATIONWIDEBATH COM LLC
Entity Type:Organization
Organization Name:NATIONWIDEBATH COM LLC
Other - Org Name:TREASURE VALLEY FIBERGLASS REPAIR, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KLAUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUTTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-939-1595
Mailing Address - Street 1:PO BOX 50122
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-0963
Mailing Address - Country:US
Mailing Address - Phone:208-939-1595
Mailing Address - Fax:208-939-1595
Practice Address - Street 1:647 S STIBNITE AVE
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1992
Practice Address - Country:US
Practice Address - Phone:208-939-1595
Practice Address - Fax:208-939-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment