1841497013 NPI number — WESTRIDGE OBGYN PC

Table of content: (NPI 1841497013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841497013 NPI number — WESTRIDGE OBGYN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTRIDGE OBGYN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841497013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8410 W THOMAS RD BLDG 3
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85037-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-247-1100
Provider Business Mailing Address Fax Number:
623-849-9004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8410 W THOMAS RD BLDG 3
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-247-1100
Provider Business Practice Location Address Fax Number:
623-849-9004
Provider Enumeration Date:
06/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
DORA
Authorized Official Middle Name:
OLIVIA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
623-247-1100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  20584 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141359 . This is a "LORENZO C. BOYCE MD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 154302 . This is a "ROBERT L. GALLAI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".