Healthcare Provider Details

I. General information

NPI: 1831536267
Provider Name (Legal Business Name): FAMILY MEDICAL SUPPLY AND CPAP STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 KING ST
LA CROSSE WI
54601-4107
US

IV. Provider business mailing address

624 KING ST
LA CROSSE WI
54601-4107
US

V. Phone/Fax

Practice location:
  • Phone: 608-791-1100
  • Fax: 608-791-1120
Mailing address:
  • Phone: 507-450-9569
  • 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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK CHARLES HOLZER
Title or Position: OWNER
Credential:
Phone: 507-895-6124