Provider Demographics
NPI:1306859707
Name:WESTSIDE CARDIOLOGY PC
Entity Type:Organization
Organization Name:WESTSIDE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-846-0406
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-0533
Mailing Address - Country:US
Mailing Address - Phone:503-846-0406
Mailing Address - Fax:503-846-0408
Practice Address - Street 1:730 SE OAK ST
Practice Address - Street 2:STE I
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4245
Practice Address - Country:US
Practice Address - Phone:503-846-0406
Practice Address - Fax:503-846-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20834261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR328314OtherPROVIDENCE HEALTH PLAN
OR151016Medicaid
ORK552001OtherPACIFIC CARE
OR151016Medicaid
OR328314OtherPROVIDENCE HEALTH PLAN