Provider Demographics
NPI:1093705378
Name:WESTERN MEDICAL
Entity Type:Organization
Organization Name:WESTERN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R C/S MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-744-2739
Mailing Address - Street 1:2202 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-6804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2202 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6804
Practice Address - Country:US
Practice Address - Phone:602-257-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ030594Medicaid
AZ0337310001Medicare ID - Type UnspecifiedPHX PROVIDER ID
AZ0337310002Medicare ID - Type UnspecifiedTUC PROVIDER ID
AZ030594Medicaid