Provider Demographics
NPI:1013236462
Name:FWL MEDICAL, LLC
Entity Type:Organization
Organization Name:FWL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEATHERBURY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:800-667-9795
Mailing Address - Street 1:PO BOX 6574
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6574
Mailing Address - Country:US
Mailing Address - Phone:800-667-9795
Mailing Address - Fax:805-686-9140
Practice Address - Street 1:1109 W HIGHWAY 246
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9403
Practice Address - Country:US
Practice Address - Phone:800-667-9795
Practice Address - Fax:805-686-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101339365332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASALES PERMITOther101339365