Provider Demographics
NPI:1437434321
Name:WEST COAST HEALTHCARE, LLC
Entity type:Organization
Organization Name:WEST COAST HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRUMAN
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-789-8096
Mailing Address - Street 1:10217 MADISON GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5266
Mailing Address - Country:US
Mailing Address - Phone:702-789-8096
Mailing Address - Fax:702-380-8187
Practice Address - Street 1:10217 MADISON GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5266
Practice Address - Country:US
Practice Address - Phone:702-789-8096
Practice Address - Fax:702-430-6698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1008178853-001305S00000X, 335V00000X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No305S00000XManaged Care OrganizationsPoint of Service
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier