Provider Demographics
NPI:1003901257
Name:HEALTHWEST PC
Entity Type:Organization
Organization Name:HEALTHWEST PC
Other - Org Name:DR ROZANA ITSKOVICH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ITSKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:804-364-8802
Mailing Address - Street 1:PO BOX 28645
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-364-8802
Mailing Address - Fax:804-364-1288
Practice Address - Street 1:7660 E PARHAM ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:804-364-8802
Practice Address - Fax:804-364-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5863848Medicaid
VA1291545964657OtherAETNA
VA258592OtherANTHEM
G82692Medicare UPIN
VA5863848Medicaid