| Organization Name: | FWL MEDICAL, LLC |
| NPI Number: | 1013236462 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANK WAYNE LEATHERBURY (OWNER) |
| Mailing Address: | 1109 W Highway 246 Buellton |
| State: | CA US |
| Postal Code: | 934279403 |
| Phone Number: | 8006679795 |
| Fax Number: | 8056869140 |
| NPI Enumeration Date: | 05/25/2010 |
| NPI Last Update Date: | 06/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 101339365 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |