MEDICARE: METWEST INC.

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	291U00000X	Clinical Medical Laboratory	06D0644432	CO

General Provider Information

NPI Number	:	1598783540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METWEST INC.

Provider Business Mailing Address
First Line	:	1201 S COLLEGEVILLE RD
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-2998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7524
Country	:	US
Telephone Number	:	719-636-3707
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHARLES ALBERT BOWLES
Credential	:
Telephone Number	:	610-454-6000

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/22/2022

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