Provider Demographics
NPI:1649458217
Name:WESTERN MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:WESTERN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:310-782-3336
Mailing Address - Street 1:21081 S WESTERN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1707
Mailing Address - Country:US
Mailing Address - Phone:310-782-3333
Mailing Address - Fax:310-212-6230
Practice Address - Street 1:21081 S WESTERN AVE
Practice Address - Street 2:STE 150
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1707
Practice Address - Country:US
Practice Address - Phone:310-782-3333
Practice Address - Fax:310-212-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty