Organization
FWL MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK WAYNE LEATHERBURY II (OWNER)
(800) 667-9795
Entity
Organization
Contact information
Practice address
1109 W HIGHWAY 246, BUELLTON, CA 93427-9403
(800) 667-9795
(805) 686-9140
Mailing address
PO BOX 6574, SANTA BARBARA, CA 93160-6574
(800) 667-9795
(805) 686-9140
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
101339365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SALES PERMIT
101339365
CA
Enumeration date
05/25/2010
Last updated
06/17/2010
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