Provider Demographics
NPI:1891706982
Name:WESTMED MEDICAL, LLC
Entity type:Organization
Organization Name:WESTMED MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-840-1862
Mailing Address - Street 1:2732 S 3600 W
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1695
Mailing Address - Country:US
Mailing Address - Phone:801-840-1862
Mailing Address - Fax:801-968-4967
Practice Address - Street 1:2732 S 3600 W
Practice Address - Street 2:SUITE D
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1695
Practice Address - Country:US
Practice Address - Phone:801-840-1862
Practice Address - Fax:801-968-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5750840001Medicare NSC