Provider Demographics
NPI:1568541829
Name:WEST CORNER MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:WEST CORNER MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-673-9580
Mailing Address - Street 1:905 SOUTH PRAIRE AVENUE SUITE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301
Mailing Address - Country:US
Mailing Address - Phone:310-673-9580
Mailing Address - Fax:310-673-9587
Practice Address - Street 1:905 SOUTH PRAIRE AVE STE D
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-673-9580
Practice Address - Fax:310-673-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46171332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5895190001Medicare NSC