Provider Demographics
NPI:1497885420
Name:WHEELCHAIR DOCTOR
Entity Type:Organization
Organization Name:WHEELCHAIR DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-0874
Mailing Address - Street 1:639 24 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1246
Mailing Address - Country:US
Mailing Address - Phone:970-242-0874
Mailing Address - Fax:970-243-1466
Practice Address - Street 1:639 24 1/2 RD
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81505-1246
Practice Address - Country:US
Practice Address - Phone:970-242-0874
Practice Address - Fax:970-243-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0486814332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0800598Medicaid
CO08000598Medicaid
CO08000598Medicaid
=========001OtherROCKY MT HEALTH PLANS