Provider Demographics
NPI:1396733176
Name:WESTERN MEDICAL INFUSION, INC.
Entity type:Organization
Organization Name:WESTERN MEDICAL INFUSION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-302-8475
Mailing Address - Street 1:2202 E UNIVERSITY DR
Mailing Address - Street 2:STE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-6804
Mailing Address - Country:US
Mailing Address - Phone:602-257-9347
Mailing Address - Fax:602-275-9194
Practice Address - Street 1:2202 E UNIVERSITY DR
Practice Address - Street 2:STE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6804
Practice Address - Country:US
Practice Address - Phone:602-257-9347
Practice Address - Fax:602-275-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3935251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0328369OtherNCPDP (PHARMACY ID)
AZ881799Medicaid
AZAZ0037290OtherBC/BS ID
AZ5181030001Medicare NSC