Provider Demographics
NPI:1104080878
Name:WESTCO MEDICAL, INC.
Entity type:Organization
Organization Name:WESTCO MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYCISIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LORIN
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:BUSSELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-589-4863
Mailing Address - Street 1:1442 KINGWOOD DR # 230
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3040
Mailing Address - Country:US
Mailing Address - Phone:713-589-4863
Mailing Address - Fax:
Practice Address - Street 1:18955 N MEMORIAL DR STE 490
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4399
Practice Address - Country:US
Practice Address - Phone:713-589-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCO MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7675302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB70260Medicare UPIN