Provider Demographics
NPI:1932322286
Name:MED-WEST
Entity Type:Organization
Organization Name:MED-WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-591-2355
Mailing Address - Street 1:5536 PHILADELPHIA ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5536 PHILADELPHIA ST
Practice Address - Street 2:SUITE H
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7533
Practice Address - Country:US
Practice Address - Phone:909-591-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46177332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5959300001Medicare NSC