=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114089919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WHEELCHAIR CONNECTION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5671 E FOUNTAIN WAY
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93727-7813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-292-5224
-----------------------------------------------------
Fax | 559-291-1867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5671 E FOUNTAIN WAY
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93727-7813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-292-5224
-----------------------------------------------------
Fax | 559-291-1867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAMES WILLIAM ROYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-292-5224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 102458
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------