1902922669 NPI number — WEST END MEDICAL CENTERS INC

Table of content: (NPI 1902922669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902922669 NPI number — WEST END MEDICAL CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST END MEDICAL CENTERS INC
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:
THE FAMILY HEALTH CENTER AT WEST END PHARMACY
Provider Other Organization Name Type Code:
3
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:
1902922669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
868 YORK AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30310-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-758-8988
Provider Business Mailing Address Fax Number:
888-331-3565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
868 YORK AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30310-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-758-8988
Provider Business Practice Location Address Fax Number:
888-331-3565
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEARLES
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
404-758-8988

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHRE008261 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2020155 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00232713A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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