Provider Demographics
NPI:1255998290
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:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:909-908-3920
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 1:8322 CLAIREMONT MESA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1317
Practice Address - Country:US
Practice Address - Phone:909-477-3117
Practice Address - Fax:909-303-9244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST COAST DME & SUPPLIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty