Provider Demographics
NPI:1922330018
Name:BUFFALO WHEELCHAIR, INC.
Entity Type:Organization
Organization Name:BUFFALO WHEELCHAIR, INC.
Other - Org Name:FORT MYERS OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-630-6357
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:610-630-6357
Mailing Address - Fax:
Practice Address - Street 1:14261 S TAMIAMI TRL
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1911
Practice Address - Country:US
Practice Address - Phone:239-561-2424
Practice Address - Fax:239-561-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUFFALO WHEELCHAIR, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-01
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL326792332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001906700Medicaid
FL001906700Medicaid