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Organization
WESTERN HEALTHCARE IND INC
Active
Organization
WESTERN HEALTHCARE IND INC
Active
Other names
northern medical supply company
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCENT LEROY DESTIGTER RCP 9059 (CEO/OWNER)
(209) 223-7306
Entity
Organization
Contact information
Practice address
825 N STATE HIGHWAY 49-88, JACKSON, CA 95642-2041
(209) 223-7306
(209) 223-7309
Mailing address
825 N STATE HIGHWAY 49-88, P.O.BOX 608, JACKSON, CA 95642-2041
(209) 223-7306
(209) 223-7309
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
102453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME00219F
—
CA
Enumeration date
06/09/2006
Last updated
08/14/2013
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