1770779720 NPI number — WESTBROOK OB/GYN, INC.

Table of content: (NPI 1770779720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770779720 NPI number — WESTBROOK OB/GYN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTBROOK OB/GYN, 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:
1770779720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 13TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44708-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-455-5231
Provider Business Mailing Address Fax Number:
330-455-1403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 13TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44708-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-455-5231
Provider Business Practice Location Address Fax Number:
330-455-1403
Provider Enumeration Date:
09/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAZZOLI
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
HIRAM
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
330-455-5231

Provider Taxonomy Codes

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

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

  • Identifier: 0971104 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: WE9264621 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000163741 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182566 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 734099 . This is a "BUCKEYE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104605 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2012181 . This is a "HOMETOWN HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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