MEDICARE: WESTERN HOME CARE, LLC

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	3336H0001X	Home Infusion Therapy Pharmacy	PH02658	NV
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	PH02658	NV
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	332BX2000X	Oxygen Equipment & Supplies (DME)	MP00196	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407814064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN HOME CARE, LLC

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	:	702-914-7337
Fax Number	:	702-914-7304

Authorized Official
Title or Position	:	COO
Name	:	MR. JASON ALLEN SMIDT
Credential	:
Telephone Number	:	602-252-5000

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	12/01/2010

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Directions to “WESTERN HOME CARE, LLC ” Practice Location

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