Provider Demographics
NPI:1821220955
Name:WESTERN CPAP SUPPLY LLC
Entity Type:Organization
Organization Name:WESTERN CPAP SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:308-633-3000
Mailing Address - Street 1:416 VALLEY VIEW DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1486
Mailing Address - Country:US
Mailing Address - Phone:308-633-3000
Mailing Address - Fax:308-633-3001
Practice Address - Street 1:4100 LARAMIE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1969
Practice Address - Country:US
Practice Address - Phone:307-426-4012
Practice Address - Fax:308-633-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWD-1197 WY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1053472191Medicaid
WY1053472191Medicaid