Provider Demographics
NPI:1255480877
Name:WESCO MEDICAL SUPPLY &EQUIPMENT CO. INC.
Entity Type:Organization
Organization Name:WESCO MEDICAL SUPPLY &EQUIPMENT CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMUDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-769-0614
Mailing Address - Street 1:701 HIGHLAND SPRINGS AVE
Mailing Address - Street 2:#4
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2550
Mailing Address - Country:US
Mailing Address - Phone:951-769-0614
Mailing Address - Fax:951-769-0624
Practice Address - Street 1:701 HIGHLAND SPRINGS AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2550
Practice Address - Country:US
Practice Address - Phone:951-769-0614
Practice Address - Fax:951-769-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1157310002Medicare NSC