Provider Demographics
NPI:1053472191
Name:WESTERN CPAP SUPPLY, LLC
Entity Type:Organization
Organization Name:WESTERN CPAP SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:308-633-3000
Mailing Address - Street 1:2855 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2202
Mailing Address - Country:US
Mailing Address - Phone:308-633-3002
Mailing Address - Fax:308-633-3001
Practice Address - Street 1:2855 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2202
Practice Address - Country:US
Practice Address - Phone:308-633-3002
Practice Address - Fax:308-633-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025548500Medicaid
134338749 69361 0000OtherTRICARE
NE09054OtherBCBS NEBRASKA
134338749 69361 0000OtherTRICARE