MEDICARE: WESTERN HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	333600000X	Pharmacy	200035-424	NV
3	3336H0001X	Home Infusion Therapy Pharmacy	2000035-424	NV

General Provider Information

NPI Number	:	1538469267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN HOME CARE

Provider Business Mailing Address
First Line	:	1626 S EDWARD DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-6200
Country	:	US
Telephone Number	:	602-252-5000
Fax Number	:	602-323-5070

Provider Business Practice Location Address
First Line	:	4035 E POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3992
Country	:	US
Telephone Number	:	702-262-5500
Fax Number	:	702-262-9997

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ROBERT A COSTON
Credential	:	BILLING MANAGER
Telephone Number	:	480-246-3950

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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Directions to “WESTERN HOME CARE ” Practice Location

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