Provider Demographics
NPI:1093878092
Name:WEST STATION ENTERPRISE INC
Entity Type:Organization
Organization Name:WEST STATION ENTERPRISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-826-3865
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691
Mailing Address - Country:US
Mailing Address - Phone:254-826-5131
Mailing Address - Fax:254-826-7071
Practice Address - Street 1:1579 TOKIO RD
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691
Practice Address - Country:US
Practice Address - Phone:254-826-5131
Practice Address - Fax:254-826-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6757332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008785Medicare ID - Type Unspecified
D67549Medicare UPIN