Provider Demographics
NPI:1538125703
Name:WESTSIDE CLINIC
Entity Type:Organization
Organization Name:WESTSIDE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TREASURE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-221-3350
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-0643
Mailing Address - Country:US
Mailing Address - Phone:620-221-3350
Mailing Address - Fax:
Practice Address - Street 1:221 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2718
Practice Address - Country:US
Practice Address - Phone:620-221-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100213690AMedicaid
KS016129Medicare ID - Type Unspecified