Provider Demographics
NPI:1396926184
Name:THE WHEELCHAIR PLACE
Entity type:Organization
Organization Name:THE WHEELCHAIR PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-855-9099
Mailing Address - Street 1:920 TATE BLVD SE STE 104
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4032
Mailing Address - Country:US
Mailing Address - Phone:828-855-9099
Mailing Address - Fax:828-855-9098
Practice Address - Street 1:920 TATE BLVD SE STE 104
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4032
Practice Address - Country:US
Practice Address - Phone:828-855-9099
Practice Address - Fax:828-855-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704827Medicaid
NC7704827Medicaid