Organization Name: | WESTMED MEDICAL OF IDAHO, LLC |
NPI Number: | 1093800518 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONATHAN LARSEN (MANAGER) |
Mailing Address: | 5775 Industry Way Ste 2 Chubbuck |
State: | ID US |
Postal Code: | 84321 |
Phone Number: | 2082376600 |
Fax Number: | 2082376655 |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |