Healthcare Provider Details

I. General information

NPI: 1265724934
Provider Name (Legal Business Name): WHEELER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 N 7TH AVE
PHOENIX AZ
85013-4107
US

IV. Provider business mailing address

3118 N 7TH AVE
PHOENIX AZ
85013-4107
US

V. Phone/Fax

Practice location:
  • Phone: 480-656-9177
  • Fax: 866-401-1401
Mailing address:
  • Phone: 480-656-9177
  • Fax: 866-401-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAMON CARL WHEELER
Title or Position: PRESIDENT
Credential:
Phone: 480-656-9177