Provider Demographics
NPI:1699986372
Name:MEDWEST ORTHOPEDICS INC
Entity type:Organization
Organization Name:MEDWEST ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRULAC
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:310-920-9768
Mailing Address - Street 1:PO BOX 3531
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1531
Mailing Address - Country:US
Mailing Address - Phone:310-798-1914
Mailing Address - Fax:310-376-2748
Practice Address - Street 1:811 N CATALINA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2133
Practice Address - Country:US
Practice Address - Phone:310-798-1914
Practice Address - Fax:310-376-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309960332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies