Provider Demographics
NPI:1346516010
Name:EASTSIDE PRIMARY CARE
Entity Type:Organization
Organization Name:EASTSIDE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TASNIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-753-6300
Mailing Address - Street 1:872 OHIO PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245
Mailing Address - Country:US
Mailing Address - Phone:513-753-6300
Mailing Address - Fax:
Practice Address - Street 1:872 OHIO PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245
Practice Address - Country:US
Practice Address - Phone:513-753-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty