Provider Demographics
NPI:1861876112
Name:WESTSTAR MEDICAL LLC
Entity type:Organization
Organization Name:WESTSTAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:JD/LLM
Authorized Official - Phone:888-661-4486
Mailing Address - Street 1:3370 N HAYDEN RD STE 123
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6632
Mailing Address - Country:US
Mailing Address - Phone:888-861-4486
Mailing Address - Fax:
Practice Address - Street 1:9015 E VIA LINDA STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5410
Practice Address - Country:US
Practice Address - Phone:888-661-4486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2085583291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D2085583OtherCMS CLIA ID NUMBER 03D2085583