Provider Demographics
NPI:1083304604
Name:POWER WHEELS MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:POWER WHEELS MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-459-3047
Mailing Address - Street 1:1647 W AVENUE J STE 105
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2881
Mailing Address - Country:US
Mailing Address - Phone:661-471-9081
Mailing Address - Fax:
Practice Address - Street 1:1647 W AVENUE J STE 105
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2881
Practice Address - Country:US
Practice Address - Phone:661-471-9081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty