Basic Information
| Provider Information | |||||||||
| NPI: | 1093755597 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE WHEELCHAIR SHOP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1332 UPLAND DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770434719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680696 | ||||||||
| FaxNumber: | 7134681517 | ||||||||
| Practice Location | |||||||||
| Address1: | 1332 UPLAND DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770434719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680696 | ||||||||
| FaxNumber: | 7134681517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RICE | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7134680696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | X | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.