Provider Demographics
NPI:1386981165
Name:MDW INNOVATIONS LLC
Entity type:Organization
Organization Name:MDW INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-613-2240
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2381
Mailing Address - Country:US
Mailing Address - Phone:928-613-2240
Mailing Address - Fax:
Practice Address - Street 1:1960 S ARIZONA AVE
Practice Address - Street 2:APT B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5784
Practice Address - Country:US
Practice Address - Phone:928-613-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment