Provider Demographics
NPI:1760417323
Name:WESCO MEDICAL SUPPLY&EQUIPMENT CO
Entity Type:Organization
Organization Name:WESCO MEDICAL SUPPLY&EQUIPMENT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMUDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:909-370-0335
Mailing Address - Street 1:1359 N MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2561
Mailing Address - Country:US
Mailing Address - Phone:909-370-0335
Mailing Address - Fax:
Practice Address - Street 1:1359 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2561
Practice Address - Country:US
Practice Address - Phone:909-370-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADME02460F332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1157310002Medicare ID - Type Unspecified
CA1157310001Medicare ID - Type Unspecified