Healthcare Provider Details

I. General information

NPI: 1548909625
Provider Name (Legal Business Name): WOW WHEELS ON WHEELS 'LLC'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 ENGLISH SADDLE RD
FLORISSANT MO
63034-3429
US

IV. Provider business mailing address

1183 ENGLISH SADDLE RD
FLORISSANT MO
63034-3429
US

V. Phone/Fax

Practice location:
  • Phone: 314-749-2615
  • Fax:
Mailing address:
  • Phone: 314-749-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 314-749-2615