Healthcare Provider Details

I. General information

NPI: 1255502787
Provider Name (Legal Business Name): MEDWEST, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 REDWING DR
BIRMINGHAM AL
35243-3046
US

IV. Provider business mailing address

PO BOX 430226
BIRMINGHAM AL
35243-1226
US

V. Phone/Fax

Practice location:
  • Phone: 205-977-7727
  • Fax: 205-969-5757
Mailing address:
  • Phone: 205-977-7727
  • Fax: 205-969-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN FREDERICK WEST SR.
Title or Position: VP OF CORPORATE DEVELOPMENT
Credential: NA
Phone: 205-253-8624