Provider Demographics
NPI:1942380068
Name:WESTLAKE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:WESTLAKE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-721-9013
Mailing Address - Street 1:13455 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-6150
Mailing Address - Country:US
Mailing Address - Phone:540-721-9013
Mailing Address - Fax:540-721-9083
Practice Address - Street 1:13455 BOOKER T WASHINGTON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6150
Practice Address - Country:US
Practice Address - Phone:540-721-9013
Practice Address - Fax:540-721-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009233332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138589OtherANTHEM BC/BS NON-PAR
VA4890840001Medicare NSC