Basic Information
| Provider Information | |||||||||
| NPI: | 1316999568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONROE WHEELCHAIR INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2165 BRIGHTON HENRIETTA TOWN LINE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146232755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853853920 | ||||||||
| FaxNumber: | 5853856966 | ||||||||
| Practice Location | |||||||||
| Address1: | 6724 THOMPSON RD | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132112183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154452220 | ||||||||
| FaxNumber: | 3154452059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | WESTERDAHL | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5853853920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 040401000140 | 01 | FIDELIS CARE | OTHER | 000001796 | 01 | BC/BS OF CENTRAL NEW YORK | OTHER | 888336 | 01 | MVP | OTHER | 02632671 | 05 | NY | MEDICAID | 64249 | 01 | DMENSION BENEFIT MGMT | OTHER | 7183753 | 01 | AETNA | OTHER | 9660309 | 01 | GHI | OTHER | 000551000003 | 01 | HEALTHNOW | OTHER |