Healthcare Provider Details

I. General information

NPI: 1396733176
Provider Name (Legal Business Name): WESTERN MEDICAL INFUSION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 E UNIVERSITY DR STE B
PHOENIX AZ
85034-6804
US

IV. Provider business mailing address

2202 E UNIVERSITY DR STE B
PHOENIX AZ
85034-6804
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-9347
  • Fax: 602-275-9194
Mailing address:
  • Phone: 602-257-9347
  • Fax: 602-275-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number3935
License Number StateAZ

VIII. Authorized Official

Name: DENNIS CROWELL
Title or Position: PRESIDENT
Credential:
Phone: 602-302-8475