Provider Demographics
NPI:1215214374
Name:WESTSIDE OB/GYN CENTER, PA
Entity Type:Organization
Organization Name:WESTSIDE OB/GYN CENTER, PA
Other - Org Name:WESTSIDE WOMEN'S CENTER, A DIVISION OF WESTSIDE OB/GYN CENTER, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:336-494-2060
Mailing Address - Street 1:1091 KIRKPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9714
Mailing Address - Country:US
Mailing Address - Phone:336-494-2060
Mailing Address - Fax:336-538-1895
Practice Address - Street 1:1694 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9700
Practice Address - Country:US
Practice Address - Phone:336-494-2060
Practice Address - Fax:336-538-1895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE OB/GYN CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty