Provider Demographics
NPI:1659468288
Name:CHERCO INC
Entity Type:Organization
Organization Name:CHERCO INC
Other - Org Name:BEDPAN BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:DME PROVIDER
Authorized Official - Phone:307-472-3012
Mailing Address - Street 1:4190 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6104
Mailing Address - Country:US
Mailing Address - Phone:307-472-3012
Mailing Address - Fax:307-472-3139
Practice Address - Street 1:4190 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6104
Practice Address - Country:US
Practice Address - Phone:307-472-3012
Practice Address - Fax:307-472-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY01007561332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3330801OtherWORKERS COMPENSATION BA#
WY314122OtherBLUECROSS BLUESHIELD
WY5171270001Medicare ID - Type Unspecified