Provider Demographics
NPI:1033201140
Name:WEST PARK MEDICAL CORP
Entity Type:Organization
Organization Name:WEST PARK MEDICAL CORP
Other - Org Name:NORTHWEST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-849-1869
Mailing Address - Street 1:4136 N 75TH AVE #116
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-3100
Mailing Address - Country:US
Mailing Address - Phone:623-849-1869
Mailing Address - Fax:623-849-5880
Practice Address - Street 1:4136 N 75TH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3171
Practice Address - Country:US
Practice Address - Phone:623-849-1869
Practice Address - Fax:623-849-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103115Medicare PIN