Provider Demographics
NPI:1952542482
Name:MEDIWEDGE INC
Entity Type:Organization
Organization Name:MEDIWEDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-623-1199
Mailing Address - Street 1:9631 PALM RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4433
Mailing Address - Country:US
Mailing Address - Phone:813-623-1199
Mailing Address - Fax:
Practice Address - Street 1:9631 PALM RIVER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4433
Practice Address - Country:US
Practice Address - Phone:813-623-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIWEDGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies