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General NPI Number Information
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NPI Number | 1306242912
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Entity Type | Organization
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Legal Business Name | YOUR CPAP STORE
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 11/08/2014
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Provider Practice Location Address
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Address Line | 800 WISCONSIN ST BLDG D02 SUITE 420B
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3588
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Country | US
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Telephone | 715-514-3608
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Fax | 715-514-3609
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Provider Business Mailing Address
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Address Line | PO BOX 65 BANBURY PLACE 800 WISCONSIN ST
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City | EAU CLAIRE
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State | WI
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Zip | 54702-0065
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Country | US
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Telephone | 715-514-3608
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Fax | 715-514-3609
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Authorized Official
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Title or Position | CEO
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Name | MR. TODD W MILLER
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Credential |
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Telephone | 715-514-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 036102855077304
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License Number State | WI
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