Provider Demographics
NPI:1407932098
Name:WESTSIDE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WESTSIDE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOCHENEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-297-5581
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:STE 230
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-445-3235
Mailing Address - Fax:503-790-2293
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-5581
Practice Address - Fax:503-297-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR003335OtherREGENCE BLUE CROSS OF OR
OR287766Medicaid
ORCT1677OtherRAILROAD MEDICARE/PALMETT
ORR0000WCRCYMedicare PIN