MEDICARE: WESTLAKE MEDICAL EQUIPMENT, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0206009233	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138589	OTHER	VA	ANTHEM BC/BS NON-PAR

General Provider Information

NPI Number	:	1942380068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTLAKE MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	13455 BOOKER T WASHINGTON HWY
Second Line	:	SUITE 101
City	:	MONETA
State	:	VA
Zip	:	24121-6150
Country	:	US
Telephone Number	:	540-721-9013
Fax Number	:	540-721-9083

Provider Business Practice Location Address
First Line	:	13455 BOOKER T WASHINGTON HWY
Second Line	:	SUITE 101
City	:	MONETA
State	:	VA
Zip	:	24121-6150
Country	:	US
Telephone Number	:	540-721-9013
Fax Number	:	540-721-9083

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADAM OWEN
Credential	:
Telephone Number	:	540-721-9013

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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