Provider Demographics
NPI:1871782557
Name:PATRICIA G. FOSDICK LUEDDE
Entity type:Organization
Organization Name:PATRICIA G. FOSDICK LUEDDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOSDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-278-8646
Mailing Address - Street 1:46 W CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1617
Mailing Address - Country:US
Mailing Address - Phone:517-278-8646
Mailing Address - Fax:517-278-4669
Practice Address - Street 1:46 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1617
Practice Address - Country:US
Practice Address - Phone:517-278-8646
Practice Address - Fax:517-278-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6019320001Medicare NSC