Provider Demographics
NPI:1245388693
Name:WESTSIDE UROLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:WESTSIDE UROLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-648-6611
Mailing Address - Street 1:333 SE 7TH AVE STE 4500
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4177
Mailing Address - Country:US
Mailing Address - Phone:503-648-6611
Mailing Address - Fax:503-640-3178
Practice Address - Street 1:333 SE 7TH AVE STE 4500
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4177
Practice Address - Country:US
Practice Address - Phone:503-648-6611
Practice Address - Fax:503-640-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287129Medicaid
ORR110057Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER