Provider Demographics
NPI:1407809627
Name:HELOISE D WESTBROOK MD PC
Entity Type:Organization
Organization Name:HELOISE D WESTBROOK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELOISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESTBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:270-641-0526
Mailing Address - Street 1:2233 W EVERLY BROTHERS BLVD STE II-C
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-5405
Mailing Address - Country:US
Mailing Address - Phone:270-641-0526
Mailing Address - Fax:631-329-6951
Practice Address - Street 1:2233 W EVERLY BROTHERS BLVD STE II-C
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5405
Practice Address - Country:US
Practice Address - Phone:270-641-0526
Practice Address - Fax:270-641-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK270401OtherMEDICARE PTAN
NDN711321Medicare PIN