Healthcare Provider Details

I. General information

NPI: 1942380068
Provider Name (Legal Business Name): WESTLAKE MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13455 BOOKER T WASHINGTON HWY SUITE 101
MONETA VA
24121-6150
US

IV. Provider business mailing address

13455 BOOKER T WASHINGTON HWY SUITE 101
MONETA VA
24121-6150
US

V. Phone/Fax

Practice location:
  • Phone: 540-721-9013
  • Fax: 540-721-9083
Mailing address:
  • Phone: 540-721-9013
  • Fax: 540-721-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0206009233
License Number StateVA

VIII. Authorized Official

Name: MR. ADAM OWEN
Title or Position: OWNER
Credential:
Phone: 540-721-9013