Organization
WESTMED MEDICAL OF IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN LARSEN (MANAGER)
(435) 792-6014
Entity
Organization
Contact information
Practice address
5775 INDUSTRY WAY, STE 2, CHUBBUCK, ID 84321
(208) 237-6600
(208) 237-6655
Mailing address
953 W 700 N, STE 110, LOGAN, UT 84321
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
10/03/2006
Last updated
08/22/2020
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