Provider Demographics
NPI:1861897324
Name:WAVE MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:WAVE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:251-990-0708
Mailing Address - Street 1:333 GREENO RD S
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1930
Mailing Address - Country:US
Mailing Address - Phone:251-990-0708
Mailing Address - Fax:
Practice Address - Street 1:333 GREENO RD S
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1930
Practice Address - Country:US
Practice Address - Phone:251-990-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1370OtherALABAMA BOARD OF HOME MEDICAL EQUIPMENT LICENSE
7334850001Medicare NSC