1306941752 NPI number — WESTSIDE HEALTH SERVICES, INC.

Table of content: (NPI 1306941752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306941752 NPI number — WESTSIDE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTSIDE HEALTH SERVICES, 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:
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:
1306941752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 GENESEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14611-3634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-436-3040
Provider Business Mailing Address Fax Number:
585-295-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14608-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-254-6480
Provider Business Practice Location Address Fax Number:
585-295-6009
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOHUE
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
585-436-3040

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  2701220R , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00355353 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: G0182661590 . This is a "BLUE CHOICE OF ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com