=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285031286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHEELCHAIR AND WALKER RENTALS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2014
-----------------------------------------------------
Last Update Date | 11/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 W MCGAFFEY ST
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-623-0799
-----------------------------------------------------
Fax | 575-208-0505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 512301
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79951-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-544-7144
-----------------------------------------------------
Fax | 915-544-1174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | JOGALE COULTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-544-7144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------