Provider Demographics
NPI:1891213476
Name:MENDING MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:MENDING MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-971-8708
Mailing Address - Street 1:3111 E WASHINGTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4330
Mailing Address - Country:US
Mailing Address - Phone:608-856-4010
Mailing Address - Fax:262-923-1231
Practice Address - Street 1:3111 E WASHINGTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4330
Practice Address - Country:US
Practice Address - Phone:608-856-4010
Practice Address - Fax:262-923-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies