Provider Demographics
NPI:1689943987
Name:WANTECH
Entity Type:Organization
Organization Name:WANTECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALVA
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-605-1789
Mailing Address - Street 1:610 N MAIN ST
Mailing Address - Street 2:SUITE 252
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3311
Mailing Address - Country:US
Mailing Address - Phone:540-605-1789
Mailing Address - Fax:540-605-1789
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:SUITE 252
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3311
Practice Address - Country:US
Practice Address - Phone:540-605-1789
Practice Address - Fax:540-605-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment