MEDICARE: ROBERT WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	19797LY	IL
2	343900000X	Non-emergency Medical Transport (VAN)	20303LY	IL
3	343900000X	Non-emergency Medical Transport (VAN)	20346LY	IL

General Provider Information

NPI Number	:	1376850156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WHEELER

Provider Business Mailing Address
First Line	:	231 SAINT LOUIS RD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2431
Country	:	US
Telephone Number	:	618-346-1568
Fax Number	:	618-692-1202

Provider Business Practice Location Address
First Line	:	231 SAINT LOUIS RD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2431
Country	:	US
Telephone Number	:	618-346-1568
Fax Number	:	618-692-1202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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Directions to “ ROBERT WHEELER ” Practice Location

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