MEDICARE: WHEELCHAIR GUY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598789257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEELCHAIR GUY, LLC

Provider Business Mailing Address
First Line	:	3800 S RIVER RD
Second Line	:	UNIT A
City	:	WEST BEND
State	:	WI
Zip	:	53095-7845
Country	:	US
Telephone Number	:	262-353-3260
Fax Number	:	262-353-3454

Provider Business Practice Location Address
First Line	:	3800 S RIVER RD
Second Line	:	UNIT A
City	:	WEST BEND
State	:	WI
Zip	:	53095-7845
Country	:	US
Telephone Number	:	262-353-3260
Fax Number	:	262-353-3454

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN CANTRALL
Credential	:
Telephone Number	:	262-353-3260

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/21/2022

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Directions to “WHEELCHAIR GUY, LLC ” Practice Location

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