Provider Demographics
NPI:1154499416
Name:NATIONAL MEDICAL ENTERPRISE
Entity Type:Organization
Organization Name:NATIONAL MEDICAL ENTERPRISE
Other - Org Name:NATIONAL MEDICAL ENTERPRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERWIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:I
Authorized Official - Credentials:O&P FITTER
Authorized Official - Phone:214-562-2571
Mailing Address - Street 1:934 GARDEN WALK BLVD
Mailing Address - Street 2:#1104
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8517
Mailing Address - Country:US
Mailing Address - Phone:121-456-2257
Mailing Address - Fax:
Practice Address - Street 1:934 GARDEN WALK BLVD
Practice Address - Street 2:#1104
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-8517
Practice Address - Country:US
Practice Address - Phone:121-456-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies