Provider Demographics
NPI:1164742375
Name:SHOCKWAVE SYSTEMS, LLC
Entity Type:Organization
Organization Name:SHOCKWAVE SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-608-0900
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-0976
Mailing Address - Country:US
Mailing Address - Phone:330-533-5954
Mailing Address - Fax:330-533-0384
Practice Address - Street 1:5653 WILLIAMSBURG CIR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3761
Practice Address - Country:US
Practice Address - Phone:330-533-5954
Practice Address - Fax:330-533-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty