Basic Information
| Provider Information | |||||||||
| NPI: | 1598783417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST PHYSICIAN SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 DAGGETT AVE | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418826311 | ||||||||
| FaxNumber: | 5418854649 | ||||||||
| Practice Location | |||||||||
| Address1: | 2614 CLOVER STREET | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418846233 | ||||||||
| FaxNumber: | 5418802840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | RICO | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5418826311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QM1300X | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.