Provider Demographics
NPI:1851542831
Name:WAM INTERNATIONAL CORPORATION
Entity Type:Organization
Organization Name:WAM INTERNATIONAL CORPORATION
Other - Org Name:WAM MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEGOKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-992-9208
Mailing Address - Street 1:20501 VENTURA BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-992-9208
Mailing Address - Fax:818-992-9209
Practice Address - Street 1:20501 VENTURA BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-992-9208
Practice Address - Fax:818-992-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101-111658OtherRESELLER PERMIT