Provider Demographics
NPI:1679734958
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/PARTNER
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 DRIVE
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 STREET
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:2008-06-19
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5815650002Medicare NSC