Provider Demographics
NPI:1457462277
Name:WESTSIDE UROLOGY LTD
Entity Type:Organization
Organization Name:WESTSIDE UROLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-849-6122
Mailing Address - Street 1:7725 N 43RD AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5770
Mailing Address - Country:US
Mailing Address - Phone:623-849-6122
Mailing Address - Fax:
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5770
Practice Address - Country:US
Practice Address - Phone:623-849-6122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0838000OtherBCBS
AZ218356Medicaid
AZAZ0838000OtherBCBS