Provider Demographics
NPI:1811190754
Name:THE WHEELCHAIR STORE
Entity Type:Organization
Organization Name:THE WHEELCHAIR STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-228-8210
Mailing Address - Street 1:PO BOX 35228
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-0228
Mailing Address - Country:US
Mailing Address - Phone:216-228-8210
Mailing Address - Fax:216-252-4930
Practice Address - Street 1:5290 COMMERCE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1271
Practice Address - Country:US
Practice Address - Phone:216-228-8210
Practice Address - Fax:216-252-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2900114Medicaid
OH5909510001Medicare NSC