Provider Demographics
NPI:1891374310
Name:WEST COAST DME & SUPPLIES LLC
Entity Type:Organization
Organization Name:WEST COAST DME & SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-477-3117
Mailing Address - Street 1:1835 CHICAGO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2309
Mailing Address - Country:US
Mailing Address - Phone:909-477-3117
Mailing Address - Fax:
Practice Address - Street 1:41331 12TH ST W STE 103
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1423
Practice Address - Country:US
Practice Address - Phone:909-477-3117
Practice Address - Fax:909-303-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies