Provider Demographics
NPI:1669776126
Name:WOLF MEDICAL INC.
Entity type:Organization
Organization Name:WOLF MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:QUELLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-233-8200
Mailing Address - Street 1:1715 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1623
Mailing Address - Country:US
Mailing Address - Phone:706-233-8200
Mailing Address - Fax:706-233-8277
Practice Address - Street 1:1715 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1623
Practice Address - Country:US
Practice Address - Phone:706-233-8200
Practice Address - Fax:706-233-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20115654383332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6527090001Medicare NSC