Provider Demographics
NPI:1497711139
Name:WESTSIDE FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:WESTSIDE FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-878-4541
Mailing Address - Street 1:100 N MURRAY HILL RD
Mailing Address - Street 2:PO BOX 28144
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-878-4541
Mailing Address - Fax:614-878-6228
Practice Address - Street 1:100 N MURRAY HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-878-4541
Practice Address - Fax:614-878-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0660388Medicaid
OHWE9923751Medicare ID - Type Unspecified