Provider Demographics
NPI:1942779640
Name:FORMA MEDICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:FORMA MEDICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:MORRISEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-536-3375
Mailing Address - Street 1:107 ORANGE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3107
Mailing Address - Country:US
Mailing Address - Phone:843-536-3375
Mailing Address - Fax:843-968-9047
Practice Address - Street 1:107 ORANGE ST APT 202
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3107
Practice Address - Country:US
Practice Address - Phone:843-536-3375
Practice Address - Fax:843-968-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies