Provider Demographics
NPI:1598789257
Name:WHEELCHAIR GUY, LLC
Entity Type:Organization
Organization Name:WHEELCHAIR GUY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-353-3260
Mailing Address - Street 1:3800 S RIVER RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-7845
Mailing Address - Country:US
Mailing Address - Phone:262-353-3260
Mailing Address - Fax:262-353-3454
Practice Address - Street 1:3800 S RIVER RD
Practice Address - Street 2:UNIT A
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-7845
Practice Address - Country:US
Practice Address - Phone:262-353-3260
Practice Address - Fax:262-353-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41753800Medicaid
WI5545030001Medicare NSC