Provider Demographics
NPI:1427387323
Name:WESTSIDE MEDICAL SUPPLY,INC
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL SUPPLY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAROSET
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-826-7502
Mailing Address - Street 1:CALLE VICTORIA 33B
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0000
Mailing Address - Country:US
Mailing Address - Phone:787-826-7502
Mailing Address - Fax:787-826-7500
Practice Address - Street 1:CALLE VICTORIA 33B
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0000
Practice Address - Country:US
Practice Address - Phone:787-826-7502
Practice Address - Fax:787-826-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies