Provider Demographics
NPI:1003139866
Name:WES SPHAR PEDORTHIC SERVICE
Entity Type:Organization
Organization Name:WES SPHAR PEDORTHIC SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-224-9420
Mailing Address - Street 1:C/O 2682 LA RINCONADA PLACE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3708
Mailing Address - Country:US
Mailing Address - Phone:530-224-9420
Mailing Address - Fax:530-224-1095
Practice Address - Street 1:C/O 2682 LA RINCONADA PLACE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3708
Practice Address - Country:US
Practice Address - Phone:530-224-9420
Practice Address - Fax:530-224-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1126335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier