Provider Demographics
NPI:1821075862
Name:MR. WHEELCHAIR, INC.
Entity Type:Organization
Organization Name:MR. WHEELCHAIR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-834-2810
Mailing Address - Street 1:1201 JEFFERSON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2439
Mailing Address - Country:US
Mailing Address - Phone:504-834-2810
Mailing Address - Fax:504-828-6457
Practice Address - Street 1:1201 JEFFERSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-2439
Practice Address - Country:US
Practice Address - Phone:504-834-2810
Practice Address - Fax:504-828-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC6490OtherBCBS OF LA PROVIDER #
LA1661287Medicaid
LA0769910001Medicare ID - Type UnspecifiedPROVIDER NUMBER