Provider Demographics
NPI:1699532192
Name:FUSION FORGE INC
Entity type:Organization
Organization Name:FUSION FORGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:270-775-0117
Mailing Address - Street 1:161 GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1935
Mailing Address - Country:US
Mailing Address - Phone:270-775-0117
Mailing Address - Fax:
Practice Address - Street 1:161 GREEN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE HTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1935
Practice Address - Country:US
Practice Address - Phone:270-775-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies