Provider Demographics
NPI:1245471366
Name:WESTERN MEDICAL SUPPLY SERVICES INC.
Entity type:Organization
Organization Name:WESTERN MEDICAL SUPPLY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:IKENZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-323-3600
Mailing Address - Street 1:14803 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3309
Mailing Address - Country:US
Mailing Address - Phone:310-323-3600
Mailing Address - Fax:310-323-3604
Practice Address - Street 1:14803 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3309
Practice Address - Country:US
Practice Address - Phone:310-323-3600
Practice Address - Fax:310-323-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6444550001Medicare NSC