Provider Demographics
NPI:1023180411
Name:EDMOND WHEELCHAIR REPAIR & SUPPLY, LLC
Entity Type:Organization
Organization Name:EDMOND WHEELCHAIR REPAIR & SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:NIEMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-348-7923
Mailing Address - Street 1:1608 APIAN WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3916
Mailing Address - Country:US
Mailing Address - Phone:405-348-7923
Mailing Address - Fax:405-359-5006
Practice Address - Street 1:1608 APIAN WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3916
Practice Address - Country:US
Practice Address - Phone:405-348-7923
Practice Address - Fax:405-359-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189873332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies