Provider Demographics
NPI:1396475968
Name:WAVE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:WAVE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-229-7297
Mailing Address - Street 1:4766 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6741
Mailing Address - Country:US
Mailing Address - Phone:858-822-9729
Mailing Address - Fax:
Practice Address - Street 1:4766 EDISON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6741
Practice Address - Country:US
Practice Address - Phone:858-822-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies