Provider Demographics
NPI:1316999568
Name:MONROE WHEELCHAIR INC
Entity type:Organization
Organization Name:MONROE WHEELCHAIR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-385-3920
Mailing Address - Street 1:2165 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2755
Mailing Address - Country:US
Mailing Address - Phone:585-385-3920
Mailing Address - Fax:585-385-6966
Practice Address - Street 1:6724 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-2183
Practice Address - Country:US
Practice Address - Phone:315-445-2220
Practice Address - Fax:315-445-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
040401000140OtherFIDELIS CARE
000001796OtherBC/BS OF CENTRAL NEW YORK
888336OtherMVP
NY02632671Medicaid
64249OtherDMENSION BENEFIT MGMT
7183753OtherAETNA
9660309OtherGHI
000551000003OtherHEALTHNOW
0188360004Medicare NSC