Provider Demographics
NPI:1740594506
Name:VICWEST MEDICAL EQUIPMENT & SUPPLY INC
Entity Type:Organization
Organization Name:VICWEST MEDICAL EQUIPMENT & SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMIREZOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-462-4070
Mailing Address - Street 1:5347 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1105
Mailing Address - Country:US
Mailing Address - Phone:323-462-4070
Mailing Address - Fax:323-462-4270
Practice Address - Street 1:5347 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1105
Practice Address - Country:US
Practice Address - Phone:323-462-4070
Practice Address - Fax:323-462-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000251095100018332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6563080001Medicare NSC