Provider Demographics
NPI:1366868267
Name:WESTSTAR MEDICAL, LLC
Entity Type:Organization
Organization Name:WESTSTAR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:574-532-2780
Mailing Address - Street 1:53444 ASH RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-5025
Mailing Address - Country:US
Mailing Address - Phone:800-717-6390
Mailing Address - Fax:800-717-6390
Practice Address - Street 1:4717 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5601
Practice Address - Country:US
Practice Address - Phone:800-717-6390
Practice Address - Fax:800-717-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory