Provider Demographics
NPI:1255205449
Name:CEDAR MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:CEDAR MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAWIT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-791-3147
Mailing Address - Street 1:11225 NORTH 28TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:213-791-3147
Mailing Address - Fax:
Practice Address - Street 1:11225 NORTH 28TH DRIVE
Practice Address - Street 2:STE A102-01
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:213-791-3147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies