Provider Demographics
NPI:1164003125
Name:FUSE MEDICAL
Entity Type:Organization
Organization Name:FUSE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-770-5161
Mailing Address - Street 1:43 WACO DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8327
Mailing Address - Country:US
Mailing Address - Phone:606-770-5161
Mailing Address - Fax:606-770-5168
Practice Address - Street 1:43 WACO DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8327
Practice Address - Country:US
Practice Address - Phone:606-770-5161
Practice Address - Fax:606-770-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty