Provider Demographics
NPI:1659195386
Name:CATHEDRAL LEDGE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:CATHEDRAL LEDGE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-662-2557
Mailing Address - Street 1:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-2238
Mailing Address - Country:US
Mailing Address - Phone:603-662-2557
Mailing Address - Fax:
Practice Address - Street 1:1857 WHITE MOUNTAIN HWY UNIT 1
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5158
Practice Address - Country:US
Practice Address - Phone:603-662-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies