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General NPI Number Information
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NPI Number | 1528594348
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Entity Type | Organization
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Legal Business Name | MEDIWEST SPECIALTY DISTRIBUTION LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | HORMIGUEROS OFFICE PARK PETROWEST PLAZA CARR 345 KM 1.5
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 787-248-4144
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Fax | 787-966-7303
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Provider Business Mailing Address
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Address Line | PO BOX 3795
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City | MAYAGUEZ
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State | PR
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Zip | 00681-3795
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IBSEN TORRES
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Credential |
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Telephone | 787-376-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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