Provider Demographics
NPI:1255502787
Name:MEDWEST, LLC.
Entity Type:Organization
Organization Name:MEDWEST, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CORPORATE DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WEST
Authorized Official - Suffix:SR
Authorized Official - Credentials:NA
Authorized Official - Phone:205-253-8624
Mailing Address - Street 1:PO BOX 430226
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1226
Mailing Address - Country:US
Mailing Address - Phone:205-977-7727
Mailing Address - Fax:205-969-5757
Practice Address - Street 1:4141 REDWING DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3046
Practice Address - Country:US
Practice Address - Phone:205-977-7727
Practice Address - Fax:205-969-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty