Provider Demographics
NPI:1457606147
Name:WESTERN STATES C.C.T. INC
Entity Type:Organization
Organization Name:WESTERN STATES C.C.T. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MEDICAL OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HESCH
Authorized Official - Suffix:
Authorized Official - Credentials:FPC
Authorized Official - Phone:505-660-7719
Mailing Address - Street 1:424 HARRIS RD.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87508
Mailing Address - Country:US
Mailing Address - Phone:505-454-3847
Mailing Address - Fax:505-454-3852
Practice Address - Street 1:424 HARRIS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4840
Practice Address - Country:US
Practice Address - Phone:505-454-3847
Practice Address - Fax:505-454-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM064163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport