MEDICARE: WESCO MEDICAL SUPPLY&EQUIPMENT CO

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	332B00000X	Durable Medical Equipment & Medical Supplies	DME02460F	CA

General Provider Information

NPI Number	:	1760417323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESCO MEDICAL SUPPLY&EQUIPMENT CO

Provider Business Mailing Address
First Line	:	1359 N MOUNT VERNON AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-2561
Country	:	US
Telephone Number	:	909-370-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1359 N MOUNT VERNON AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-2561
Country	:	US
Telephone Number	:	909-370-0335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	WILLIAM O. AMUDIPE
Credential	:	DME
Telephone Number	:	909-370-0335

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	12/14/2010

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