Provider Demographics
NPI:1376850156
Name:WHEELER, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RIVERBEND
Other - Middle Name:
Other - Last Name:TAXI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:231 SAINT LOUIS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2431
Mailing Address - Country:US
Mailing Address - Phone:618-346-1568
Mailing Address - Fax:618-692-1202
Practice Address - Street 1:231 SAINT LOUIS RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2431
Practice Address - Country:US
Practice Address - Phone:618-346-1568
Practice Address - Fax:618-692-1202
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19797LY343900000X
IL20303LY343900000X
IL20346LY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)