Provider Demographics
NPI:1265494355
Name:WESTSIDE OB/GYN CENTER PA
Entity Type:Organization
Organization Name:WESTSIDE OB/GYN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:336-538-1880
Mailing Address - Fax:336-538-1895
Practice Address - Street 1:1091 KIRKPATRICK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9714
Practice Address - Country:US
Practice Address - Phone:336-538-1880
Practice Address - Fax:336-538-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH43755Medicare UPIN
NCC81153Medicare UPIN
NCC86664Medicare UPIN
NCC81455Medicare UPIN
NCS42708Medicare UPIN
NCP94157Medicare UPIN