Provider Demographics
NPI:1285908632
Name:WHEELCHAIR SHOP, INC
Entity type:Organization
Organization Name:WHEELCHAIR SHOP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-872-5804
Mailing Address - Street 1:3944 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9264
Mailing Address - Country:US
Mailing Address - Phone:219-872-5804
Mailing Address - Fax:219-872-5814
Practice Address - Street 1:3944 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9264
Practice Address - Country:US
Practice Address - Phone:219-872-5804
Practice Address - Fax:219-872-5814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1100085347672332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies