Healthcare Provider Details

I. General information

NPI: 1366821977
Provider Name (Legal Business Name): WINETEER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W 75TH ST SUITE 100
PRAIRIE VILLAGE KS
66208
US

IV. Provider business mailing address

3500 W 75TH ST STE 100
PRAIRIE VILLAGE KS
66208-4129
US

V. Phone/Fax

Practice location:
  • Phone: 816-363-0600
  • Fax: 816-363-2080
Mailing address:
  • Phone: 913-380-4246
  • Fax: 816-363-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number201107880A
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number201107880A
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number201107880A
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATY DODD
Title or Position: PRINCIPAL
Credential:
Phone: 913-380-4246