Provider Demographics
NPI:1144594326
Name:TOM WIGGINTON MEDICAL, INC.
Entity Type:Organization
Organization Name:TOM WIGGINTON MEDICAL, INC.
Other - Org Name:TW MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-908-6857
Mailing Address - Street 1:12616 W 62ND TERR.
Mailing Address - Street 2:SUITE 115C
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216
Mailing Address - Country:US
Mailing Address - Phone:913-283-7725
Mailing Address - Fax:913-422-8858
Practice Address - Street 1:12616 W 62ND TERR.
Practice Address - Street 2:SUITE 115C
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216
Practice Address - Country:US
Practice Address - Phone:913-283-7725
Practice Address - Fax:913-422-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16.12180332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies