# POWER WHEELS MEDICAL SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083304604
- **Authorized official:** MR. RANDY E DEVINE (MANAGER)
- **Authorized official phone:** (323) 459-3047

## Contact information

- **Practice address:** 1647 W AVENUE J STE 105, LANCASTER, CA 93534-2881
- **Practice address phone:** (661) 471-9081
- **Mailing address:** 1647 W AVENUE J STE 105, LANCASTER, CA 93534-2881
- **Mailing address phone:** (661) 471-9081

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171WV0202X | Vehicle Modifications Contractor | — | NULL | — |
| 171WV0202X | Vehicle Modifications Contractor | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 05/08/2023
- **Last updated:** 11/20/2023