Provider Demographics
NPI:1134534225
Name:SANDUSKY WELLNESS DME LLC
Entity type:Organization
Organization Name:SANDUSKY WELLNESS DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-625-8085
Mailing Address - Street 1:3703 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5719
Mailing Address - Country:US
Mailing Address - Phone:419-625-8085
Mailing Address - Fax:419-625-6004
Practice Address - Street 1:3703 COLUMBUS AVE.
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5719
Practice Address - Country:US
Practice Address - Phone:419-625-8085
Practice Address - Fax:419-625-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies