Provider Demographics
NPI:1013147891
Name:NORTHWEST MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:NORTHWEST MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-283-2839
Mailing Address - Street 1:10 MARINE ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1470
Mailing Address - Country:US
Mailing Address - Phone:860-283-2839
Mailing Address - Fax:860-283-9468
Practice Address - Street 1:10 MARINE ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1470
Practice Address - Country:US
Practice Address - Phone:860-283-2839
Practice Address - Fax:860-283-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0003954326332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies