Healthcare Provider Details

I. General information

NPI: 1033486865
Provider Name (Legal Business Name): WHEELCHAIR ACCESS VANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6893 SUPPLY WAY
BOISE ID
83716-5539
US

IV. Provider business mailing address

6893 SUPPLY WAY
BOISE ID
83716-5539
US

V. Phone/Fax

Practice location:
  • Phone: 208-385-7647
  • Fax:
Mailing address:
  • Phone: 208-385-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: CHRIS THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 208-385-7647