Provider Demographics
NPI:1306242912
Name:YOUR CPAP STORE
Entity type:Organization
Organization Name:YOUR CPAP STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-514-3608
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:BANBURY PLACE 800 WISCONSIN ST
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-0065
Mailing Address - Country:US
Mailing Address - Phone:715-514-3608
Mailing Address - Fax:715-514-3609
Practice Address - Street 1:800 WISCONSIN ST
Practice Address - Street 2:BLDG D02 SUITE 420B
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3588
Practice Address - Country:US
Practice Address - Phone:715-514-3608
Practice Address - Fax:715-514-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI036102855077304332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies