Provider Demographics
NPI:1972564532
Name:POWERCHAIRS USA INC.
Entity type:Organization
Organization Name:POWERCHAIRS USA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-699-0399
Mailing Address - Street 1:705 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CREVE COEUR
Mailing Address - State:IL
Mailing Address - Zip Code:61610-3851
Mailing Address - Country:US
Mailing Address - Phone:309-699-0399
Mailing Address - Fax:309-699-0339
Practice Address - Street 1:705 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CREVE COEUR
Practice Address - State:IL
Practice Address - Zip Code:61610-3851
Practice Address - Country:US
Practice Address - Phone:309-699-0399
Practice Address - Fax:309-699-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid