MEDICARE: WEST TECHNICAL SERVICE CENTER 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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1942467428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST TECHNICAL SERVICE CENTER INC

Provider Business Mailing Address
First Line	:	1140 W 50TH ST
Second Line	:	SUITE 310
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-558-4020
Fax Number	:	305-558-7060

Provider Business Practice Location Address
First Line	:	1140 W 50TH ST
Second Line	:	SUITE 310
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-558-4020
Fax Number	:	305-558-7060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RELVIS HERNANDEZ
Credential	:
Telephone Number	:	305-558-4020

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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