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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