Provider Demographics
NPI:1851994164
Name:WESTLAKE DME, LLC
Entity Type:Organization
Organization Name:WESTLAKE DME, LLC
Other - Org Name:WESTLAKE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTWAN
Authorized Official - Middle Name:LAPREE
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-210-5725
Mailing Address - Street 1:PO BOX 8664
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46361-8664
Mailing Address - Country:US
Mailing Address - Phone:219-210-5725
Mailing Address - Fax:219-369-4203
Practice Address - Street 1:1413 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4524
Practice Address - Country:US
Practice Address - Phone:219-210-5725
Practice Address - Fax:219-369-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1851994164Medicaid