1639172828 NPI number — WESTFALL SURGERY CENTER LLP

Table of content: (NPI 1639172828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639172828 NPI number — WESTFALL SURGERY CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTFALL SURGERY CENTER LLP
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:
1639172828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 SENATOR KEATING BLVD.
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:
14618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-256-1330
Provider Business Mailing Address Fax Number:
585-256-3823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 SENATOR KEATING BLVD.
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:
14618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-256-1330
Provider Business Practice Location Address Fax Number:
585-256-3823
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
GARY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
585-256-1330

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  2701227R , 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: 2735782 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000400762000 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 103136CJ . This is a "PREFERRED CARE INFUSION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RQ . This is a "BLUES TRADITIONAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 014004585 . This is a "BLUES HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 103136FL . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01058511 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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