Provider Demographics
NPI:1700592136
Name:WESTSIDE MEDICAL DEVICES LLC
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL DEVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-812-1164
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 275C
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1878
Mailing Address - Country:US
Mailing Address - Phone:734-812-1164
Mailing Address - Fax:
Practice Address - Street 1:25500 MEADOWBROOK RD STE 275C
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1878
Practice Address - Country:US
Practice Address - Phone:734-812-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802975418OtherSOM