Provider Demographics
NPI:1659632370
Name:CADWELL THERAPEUTICS, INC.
Entity Type:Organization
Organization Name:CADWELL THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-991-5964
Mailing Address - Street 1:909 N KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7669
Mailing Address - Country:US
Mailing Address - Phone:855-843-5411
Mailing Address - Fax:
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-991-5964
Practice Address - Fax:586-991-5965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CADWELL THERAPEUTICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-30
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment