Provider Demographics
NPI:1427208628
Name:WESTLAKE PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:WESTLAKE PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MSP
Authorized Official - Phone:216-437-0047
Mailing Address - Street 1:1502 WEYMOUTH CIR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6192
Mailing Address - Country:US
Mailing Address - Phone:440-539-0219
Mailing Address - Fax:206-888-0360
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:411
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:216-437-0047
Practice Address - Fax:206-888-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103T00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0001Medicaid