Provider Demographics
NPI:1417942962
Name:WESTLAKE FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:WESTLAKE FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-353-9011
Mailing Address - Street 1:5623 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2901
Mailing Address - Country:US
Mailing Address - Phone:970-353-9011
Mailing Address - Fax:970-353-0306
Practice Address - Street 1:5623 W 19TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2901
Practice Address - Country:US
Practice Address - Phone:970-353-9011
Practice Address - Fax:970-353-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010583Medicaid
CO04010583Medicaid